RSSArchive for August, 2017

Ethics for Charge Nurses in Frontline Leadership

This is an excerpt from Charge Nurse Leader Program Builder.

Like your practice, your frontline leadership requires that you adhere to ethical principles (ANA, 2015). There is value added when you practice within your professional code of ethics and abide by policies, facility ethics guidelines, and legal standards, such as employee confidentiality. You often serve as advocate, negotiator, protector, preceptor, and counselor to team members, patients, and families. Additionally, you help new staff members settle into their new roles and positions and may preceptor or mentor students completing clinical assignments on your unit.

A code of ethics is a set of principles of conduct within an organization that guides decision-making and behavior (Makaroff, Storch, Pauly, & Newton, 2014). Applying ethical, legal, and policy rules is essential to the safe, effective nursing practice and leadership. Most ethics codes specify that members conduct themselves honestly, fairly, competently, and justly.

Ethics exercise: This exercise will help you consider some of these potential ethical questions and principles you may encounter as a frontline leader and ways to anticipate them with proactive problem solving (Gantt, 2014):

  • Read your specialty practice or profession’s code of ethics: What issues are discussed? What was the outcome? What might be done differently?
  • Draw on personal, practical, lived experiences: What about a situation or question was troubling? Review the Choice and Awareness Model and consider how it might apply to the ethics of the discussion or situation. This model offers one approach for ethical decision-making and working through ethical dilemmas. What other models have you used?
  • Look through books and journals on ethics that include situations testing personal or professional values, beliefs, or morals in how to perform work or interact with co-workers, colleagues, or customers/clients/patients. How do these examples fit situations you encountered during a preceptorship or mentorship? How will your decisions be affected by the ethical choices made by those in the books or journals?

Leadership in an Age-Diverse Nursing Workplace

Book excerpt from Managing the Intergenerational Nursing Team.

Your challenge is to keep all generations engaged, motivated, and satisfied in their jobs in order to increase productivity, morale, and job satisfaction. It is expensive to replace a nurse employee, so you must also find ways to decrease attrition and turnover. You are going to need to build more personal relationships with your staff nurses to increase team morale and make them feel needed and wanted.

Great leaders have a vision of the future that they can sell to others to get their buy-in. Your managerial style will benefit from having a vision of the future that your staff will support. Then you can persuade them to join as a team to bring that vision into reality. Your job is sales—selling your vision. Your job is production—giving them the tools to do the job right. And your job is cheerleader—motivating and supporting them in their efforts.

Successful and fair management of an age-diverse group begins with an open discussion of the differences between the generational cohorts while you maintain a positive attitude. Generational stereotyping can be a risky practice, so look at the needs of your diverse team in the context of their generation with caution. It would be a mistake to assume that everyone in that generation thinks the same or wants the same things. You will need to tailor your leader­ship techniques accordingly, including communication styles, conflict resolution, coaching, and motivating. Some of your staff will eagerly follow your leadership. Some of them will question and even dismiss your efforts. Knowing the preferences for each generation can provide insight to help motivate and affirm yourself during the rough times.

Generational considerations can also show you the path to solidify your work team and bring out the potential in every individual. When the team wins, you win; so set them and yourself up with every advantage to be a productive and effective work team by attending to their genera­tional needs. It will be time and energy well spent.

McCain votes no, derails “skinny repeal” in marathon session

This article appeared on Kaiser Health News on July 28, 2017.

By Michael McAuliff

WASHINGTON — Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

“The skinny bill in the Senate doesn’t even come close to honoring our promises of repealing Obamacare,” said Sen. Ron Johnson (R-Wis.). “Virtually nothing we’re doing in any of these bills and proposals are addressing the challenges, the problems, the damage done [by the Affordable Care Act].”

Staff of Senate Majority Leader Mitch McConnell (R-Ky.) crafted the new bill, which was under discussion all afternoon and posted publicly late Thursday evening.

The slimmed-down version of the Senate bill — The Health Care Freedom Act, which the White House refers to as the “freedom bill” — included an end to key elements of the health law. Among them were rollbacks of the mandates for individuals and employers to buy health insurance, changes to waivers available under Section 1332 of the ACA that would give states more leeway to alter essential benefits in insurance plans, and a repeal of the medical-device tax.

It was not immediately clear how the bill achieved savings similar to $133 billion in the House’s version of repeal legislation. An equal or better level of savings is required under the arcane budgetary process that is being used to advance the bill, known as reconciliation.

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday.

One provision that had been restored after the parliamentarian initially struck it was an attempt to defund Planned Parenthood for a year. The new provision took in at least one additional abortion provider, and was expected to survive. The funding for Planned Parenthood was to be shifted to community health centers.

Keeping the attack on Planned Parenthood solidified Murkowski and Collins’ opposition to the vote.

This new iteration of the repeal comes after two versions failed to win over the 50 GOP senators needed. But even with all the rewriting and behind-the-scenes negotiation, four senators called a press conference to declare they will not vote for this “skinny repeal” unless House Speaker Paul Ryan (R-Wis.) promises not to merely pass the measure but send it to a conference committee between the two chambers, where it can be substantively altered.

The four senators slammed the trimmed-down compromise.

“I am not going to vote for a piece of legislation that I believe is not a replacement, that politically would be the dumbest thing in history to throw this out there,” said Sen. Lindsey Graham (R-S.C.).

He said that he, Johnson and McCain and Sen. Bill Cassidy (R-La.) would not vote for the skinny repeal until Ryan pledges to “go to conference,” where Graham can include a measure to shift current Obamacare funding into a block-grant program for states.

His fear, Graham said, is that the House might simply take up and pass the skinny repeal in order to be done with it and notch a win in their seven-year battle against Obamacare.

Graham referred to estimates that said the repeal of the ACA mandates would “collapse the individual market” and leave the GOP to “own the problem at a time when Obamacare is collapsing.”

Ryan did release a statement with a conditional promise to take the bill to conference. Initially, it did not satisfy Graham or McCain. Graham and Johnson were persuaded, however, after a phone conversation with Ryan. McCain was not.

For their part, Democrats uniformly panned the GOP’s efforts.

“We’ve had one bad bill after another. There is no bill that is a good bill,” said Sen. Dianne Feinstein (D-Calif.). “Every bill takes people off health care. Every bill makes you pay more for less. There’s a race to the bottom, so to speak.”

Sen. Chris Murphy (D-Conn.), hammered the entire process: “This is nuclear grade bonkers.”