Priorities in Nursing Practice and Nursing Standards of Care

 Establishing Nursing Priorities

1. Prioritizing - decisions of which needs or problems require immediate attention or action and which ones could be delayed until a later time since they are not urgent.
2. Needs that are life-threatening or could result in harm to the client if left untreated are high priorities.
3. Actual problems or needs have higher priority than potential problems or needs.
4. Problems or needs identified by the client are of a higher priority.
5. Principles of Maslow's Hierarchy of Needs or the ABCs may guide decisions.
6. Mutual decision-making for priorities may be made with the client based on the client's needs, desires and safety.

NURSE PRACTICE ACTS

• Definition: passed by each state legislature to regulate the practice of nursing in that state
• Nurse Practice Acts define:
• Scope of Practice
• Education
• Licensure
• Professional Misconduct:
• Negligence
• The 'Impaired Nurse'
• The nurse who violates boundaries
• Administered by the Board of Nursing in each state:
• The nurse must know how their state defines professional misconduct
• For Professional Misconduct, the State Board of Nursing imposes penalties (in order of severity):
• On Probation
• Censured
• Reprimanded
• License Suspended
• License Revoked

STANDARDS OF NURSING PRACTICE AND STANDARD OF CARE

• The American Nurses Association (ANA) publishes its Standards of Nursing Practice, which defines the responsibilities of the RN to all clients for quality of care.
• Each institution sets standard of care, both across the institution and for specific clinical populations.

LEGAL RESPONSIBILITIES

• Definition: legally, a breach of the duty to provide nursing care to the client. A form of malpractice. The unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not perform in a similar set of circumstances. Malpractice is professional negligence.
• Negligence Involves Four (4) Legal Concepts
1. Duty: nurses have a legal obligation to provide nursing care to clients.
• Must meet a reasonable and prudent standard of care under the circumstances.
• Must deliver care as any other reasonable and prudent nurse of similar education and experience would, under similar circumstances.
2. Breach of Duty: failure to provide expected, reasonable standard of care under the circumstances (include errors of omission or commission)
3. Proximate Cause:
• Relationship between the breach of duty and the resulting injury.
• The injured party must prove that the nurse's action or omission led to the injury.
4. Damages: the injury and the monetary award to the plaintiff
• Example: Mr. J sues Nurse Jane for negligence. Mr. J must prove that Nurse Jane committed a breach of duty and that the breach of duty was the proximate cause of Mr. J's damages.

PROFESSIONAL MISCONDUCT

• The 'Impaired Professional'
• Remember that the impaired nurse if compromising client care.
• Be sure that the problem exists and can be proven.
• Communicate specific concerns to appropriate persons such as nurse manager or risk manager.
• Document incidents in terms of behaviors, specific times, dates - be objective.
• File a report according to the policies and procedures of the institution.
• Boundary Violations
• Definition: actions that overstep established interpersonal boundaries to meet the needs of the nurse.
• Guiding Principles in Determining Professional Boundaries:
• Nurse is responsible for setting and keeping boundaries.
• Nurse must avoid simultaneous professional and personal relationship with a client.
• Nurse must avoid flirtations.