1EAccountability and 1F Ethics

Accountability, Ethics, and Professionalism in Nursing (Module 1)

  • Recording policy in class

    • You are allowed to record lectures; no instructor objects.
    • Test reviews: desks cleared; no recording allowed due to test security.

  • Learning outcomes and where to find them

    • Learning outcomes come from the syllabus. Look at the outcomes and the exemplars, especially the bold ones, because those are the board-required topics and likely to appear on tests.
    • Concept resources accompany accountability discussions.

  • Accountability vs responsibility

    • Responsibility: being reliable and trustworthy; patients must feel they can rely on you for care.
    • Accountability: taking responsibility for your own actions.
    • As a nursing student, you are accountable to yourself, your patient, your clinical instructor, the school, the clinical site, and the board of nursing.
    • You practice as a student nurse or student LPN, not under the instructor’s license.
    • American Nurses Association Code of Ethics defines accountability as being answerable to yourself and others for your actions.
    • Accountability is essential for professional nursing: maintains competency, patient safety, quality of care. Acknowledge mistakes and learn from them to prevent recurrence.

  • Liability of student nurses

    • Student nurses are held to nursing care standards as LPN students; clinical instructors guide but do not license you.
    • You are responsible for your own decisions; you must be prepared and checked off on skills before performing them.
    • Know medications and practice standards; nurse practice acts set the legal scope of practice.
    • Completion of the program should qualify you to pass the NCLEX-PN; there are two NCLEX licensures (RN and PN).
    • We teach minimum standards to pass NCLEX; you will continue learning after licensure.

  • Nurse Practice Act and scope of practice

    • Nurse Practice Act defines scope and minimum competency levels; each state has its own act, all aiming to protect the public.
    • You should know your own scope and the scope of other disciplines (e.g., CNAs) to know what you can delegate.
    • Knowledge of facility standards and job descriptions is essential; facilities may have stricter practices than the board allows (example: CNAs performing blood sugars in some facilities—not allowed in others).
    • If a supervisor or doctor asks you to do something beyond your scope, you should speak up and decline, offering an alternative that stays within scope.
    • Licensure attestation: upon program completion, the program director signs off to the board attesting you are safe to practice.

  • Exceeding scope and employment considerations

    • When seeking employment, inquire about job descriptions, orientation length, and available mentorship.
    • Typical orientation ranges from around 4–6 weeks; broader orientation is often necessary for safe practice.
    • Ask about staff-to-patient ratios; ratios vary by unit and patient acuity (e.g., med-surg vs ICU vs pediatrics vs labor and delivery).
    • If asked to perform duties beyond scope, speak up; maintain licensure and patient safety.
    • Be aware that doctors may not know the exact scope of practice for LPNs/RNs; you must know and protect your scope.

  • Competency and ongoing learning

    • Competency means possessing the knowledge and skills needed to perform the job; high standards persist today due to broader patient access to information.
    • Competency is defined by the scope of practice and the minimum level to practice, as determined state-by-state by the Nurse Practice Act.
    • CUESN (Quality and Safety Education for Nurses) competencies are core to nursing education and practice; expect modules focusing on these across the program.
    • CUESN competencies include:
    • ext{Patient-centered care}
    • ext{Teamwork and collaboration}
    • ext{Evidence-based practice}
    • ext{Quality improvement}
    • ext{Safety}
    • ext{Informatics}
    • These modules build safe, competent care across the curriculum.

  • Patient rights, privacy, and safety frameworks

    • Patient rights are integral; healthcare facilities have responsibilities to patients (privacy, confidentiality, safety, participation in care, assistance with discharge, etc.).
    • HIPAA protects patient privacy and confidentiality; it also touches on informed consent.
    • Patient Bill of Rights (hospital standard) outlines rights such as safe care, participation in care, privacy, and fair billing explanations. Long-term care and mental health facilities have their own patient rights documents.
    • Joint Commission accreditation standards influence facility operations and reimbursement; loss of accreditation can reduce reimbursement from CMS/Medicare and Medicaid.
    • If patients feel rights are violated, they can grieve at the facility, file with Joint Commission, or pursue legal recourse.

  • Areas of nursing competence and ongoing professional development

    • Core areas include:
    • Health promotion and wellness (prevent disease, vaccinations, screenings, healthy lifestyle)
    • Illness prevention (hand hygiene, PPE, sterile technique)
    • Health restoration (early detection and recovery)
    • Caring for the dying (palliative/end-of-life care)
    • Continuing education and professional development
    • Licensure renewal every 2 years; renewal date typically falls on the last day of your birth month.
    • Common renewal options include continued education and active practice; many boards require CEUs if you have active practice hours.
    • Typical requirement example: at least 640 hours of active practice triggers requiring 15 CEUs (continuing education units).
    • Documentation is important for audits; keep a portfolio with certificates and records of CEUs.
    • Many free CEU opportunities exist: CDC courses (e.g., TB program; around 5 CEUs), Board of Nursing/CBON online activities, Medscape, National League for Nursing resources, virtual simulation sites, and professional workshops/seminars.
    • Some CEUs can be earned through attending workshops or seminars offered by the program or affiliated organizations.
    • Lifelong competency and patient safety
    • Healthcare is continually changing; ongoing education improves outcomes and maintains patient safety.
    • Board of Nursing expects nurses to maintain their own continuing competency; there are no universal reminders from the Board.
    • Additional pathways to maintain competency include returning to school (e.g., ADN programs) or obtaining certifications in specialty areas.

  • Benner’s stages of clinical competence (Novice to Expert)

    • Described by Patricia Benner: a model for how novice nurses gain competency over time
    • Stages:
    • Stage I: Novice – no real professional nursing experience (nursing student)
    • Stage II: Advanced Beginner – about 1 ext{ to } 2 ext{ years} of practice; can perform acceptably and begin to recognize situational cues
    • Stage III: Competent – about 2 ext{ to } 3 ext{ years}; can organize and prioritize care; better time management
    • Stage IV: Proficient – about 3 ext{ to } 5 ext{ years}; holistic view of patient; improved decision making
    • Stage V: Expert – typically > 5 ext{ years}; intuitive practice and highly refined assessment skills
    • Experts can move between areas; float to a new unit may require re-building competence; orientation and gradual re-learning are critical
    • Analogy: Tetris — all team members fit together to form a complete care picture; different units require different skills, and every role is essential for closing gaps in patient care
    • Emphasis on teamwork: no one role is inherently “better”; nurses from different levels and roles (RN, LPN, CNA) rely on each other to provide safe, comprehensive care

  • Professional behaviors and civility in clinical settings

    • Professional behaviors include: dressing appropriately, maintaining a clean uniform, avoiding strong odors, and minimizing extraneous jewelry
    • Positive attitude, willingness to learn, collaboration, and teamwork are essential
    • Avoid gossip, personal problems discussion in patient areas; avoid bullying
    • Do not use illegal substances; maintain professional boundaries
    • Civility vs incivility
    • Civility: respectful, polite, professional interactions; fosters trust and emotional health; supports team functioning
    • Incivility: rude or disrespectful behavior; common in high-stress healthcare settings; can impair learning and patient safety
    • Workplace factors contributing to incivility: long hours, staffing shortages, emotional stress, conflicts with leadership, poor communication
    • Ethical obligation to cultivate civility (ANA Code of Ethics): create an ethical environment, promote civility among staff
    • Personal experiences: anecdotes illustrating the impact of incivility; importance of welcoming and mentoring new nurses
    • Reporting and addressing incivility: communicate concerns to program/clinical site; administration involvement when necessary
    • Civility best practices: clear communication, respect, and collaboration; ATI Civility Mentor module as a resource (in professionalism module)
    • Assault and harassment in workplace: report any threats or violence; ethical and legal responsibilities to address them

  • Assertiveness, non-assertiveness, and communication skills

    • Assertive behavior: stand up for your beliefs and for patients; body language should align with words (eye contact, straight posture, clear, confident speech)
    • Non-assertive behavior: avoid expressing true feelings due to fear or conflict; emotionally dishonest and self-defeating
    • Aggressive behavior: dominating or demeaning others; violates others’ rights; should be avoided
    • Active listening as a de-escalation tool: listen without interrupting; show empathy and non-defensiveness; helps diffuse anger and frustration

  • Ethics in nursing: foundations, codes, and real-world dilemmas

    • Ethics defined: system of moral principles guiding professional beliefs and actions; determine what is right, permissible, and obligatory
    • Major ethical issues in healthcare: IVF, artificial insemination, surrogacy, cloning, organ donation, fetal tissue use, abortion, euthanasia/assisted suicide, advanced directives, living wills, powers of attorney, and withdrawal/insertion of feeding tubes
    • Values, morals, and beliefs
    • Values: personal worth shaping actions; sources include parents, life experiences, and religion; Elvis Presley quote about fingerprints and values
    • Morals: judgments about right vs wrong; shaped similarly by family, experience, and religion
    • Personal code of ethics: guides living and practice; nurses should know their own ethics before addressing others' beliefs
    • Ethics vs law
    • Nursing ethics: professional standards guiding practice; not legal laws
    • Nurse Practice Act: legal framework defining scope and minimum competency; binding and enforceable by the state board
    • Codes of ethics (ANA, NAPNES): guidelines for nursing practice; not legal requirements; there can be ethical and legal overlaps (e.g., patient advocacy, confidentiality)
    • Historical roots of nursing ethics
    • Nursing historically viewed as low-status; Nightingale’s work elevated the profession
    • Nightingale Pledge: considered the first code of ethics for nursing in the U.S.; serves as a moral contract to provide compassionate, competent care
    • Primary ethics codes relevant to practical nurses
    • NAPNES Code of Ethics (abbreviated): conserve life, prevent disease, promote health, fulfill duties, follow legal guidelines, maintain knowledge, respect patient beliefs, keep up with health trends, uphold laws
    • ANA Code of Ethics for Nurses: patient-centered commitment; advocate for patient rights; safety; accountability and responsibility; professional growth; collaboration; advancing the profession; explicit ethics statements
    • Four basic principles of ethics (with emphasis on respect for people as foundational)
    • Nonmaleficence: do no harm; minimize harm; ensure benefits outweigh harms; apply 10 rights of medication administration to prevent harm; use clear communication to prevent errors
    • Beneficence: do good; act in the patient’s best interest; prioritize patient welfare; respect patient wishes even if they conflict with personal beliefs; protect confidentiality and privacy
    • Autonomy: respect patient self-determination; informed consent; patient has right to know benefits, risks, alternatives; patients may have cultural/religious practices; respect decisions even if you disagree
    • Justice: fairness; equal and equitable treatment; avoid bias; tailor care to individual needs rather than giving everyone the same treatment
    • Advocacy and professional responsibilities
    • Patient advocacy is both ethical and legal; nurses advocate for patient rights and needs
    • Accountability includes reporting unsafe or noncompliant care (colleague reporting)
    • Ethical conflicts may require facilitating communication among patients, families, and doctors to honor patient wishes
    • Ethical duties in practice across settings
    • You cannot refuse to care for a patient because of disagreement with patient decisions (e.g., abortion) without risking abandonment and licensure issues
    • You can request an alternate assignment if personal beliefs conflict with patient care; maintain patient care standards via appropriate channels
    • Patient resources and recourse
    • Grievances can be filed with the facility, Joint Commission, or state regulatory bodies; legal avenues may apply in some cases

  • Historical and foundational aspects of nursing ethics

    • Nightingale Pledge presented as the first code of ethics in the U.S.; recitation emphasized during pinning ceremonies (cards provided rather than memorization)
    • Codes of ethics (ANA, NAPNES) guide professional practice and ethical decision-making; not legally binding, but strongly influence practice and professional norms

  • Practical implications for everyday practice

    • Respect patient rights and maintain confidentiality (HIPAA) while ensuring informed consent and patient participation
    • Use the 4 ethical principles to navigate dilemmas; prioritize patient safety and well-being
    • Maintain professional behavior and civility; foster supportive learning and work environments
    • Seek mentorship, adequate orientation, and ongoing education to stay competent
    • When in doubt, consult the Nurse Practice Act, facility policies, and your institution’s ethics resources; involve exam-ready exemplars from your syllabus and bold exemplars for test preparation

  • Break reminder

    • A ten-minute break is offered before continuing to ethics review and test preparation activities