NRP 477

Module 6- Foundation for Effective Leadership and Management in Ethics and the Law-2

 Introduction:  Foundation for Effective Leadership and Management in Ethics and the Law (SLOs 1,2,3,4,5,6)

Exploring Ethics and Law in Leadership:

The professional nurse has the American Nurses Association (ANA) Code of Ethics to guide our ethical behavior. As a nurse, your first priority is your patient. You have explored in other courses the ethical implications of nursing practice.  You have learned how to deal with ethical dilemmas, and who to go to for help using the chain of command. During this module, explore your required reading from the perspectives of nursing leadership. What do you do as a nurse acting as a charge nurse or in nursing management to remain a role model for ethical behavior to your staff and interdisciplinary team members? What should a nurse leader do when facing an ethical dilemma? Who does the nursing leader go to to help with such a dilemma? What should a nursing leader do when another nursing leader is unethical in their behavior? What if the leader is your superior?  (Just as you feel uncomfortable with the thoughts of dealing with your superior displaying unethical behavior, if you let your guard down and display such, your staff are in a predicament to deal with your behavior). 

Personally reflect on how your moral compass affects your ethical decision-making. What can you do as a leader to prevent moral distress? 

As you read the required reading, determine the legal ramifications of being a nursing leader. When would there be situations in which as a leader, you have to become the whistleblower to protect the patients over the actions of the place you are currently practicing? In your place of practice, what process should you take before blowing the whistle? What actions can quickly protect the patients before an improper action would lead to disaster?  For example, an assistant nursing administrator was asked to implement a new project: A remote patient telemetry monitoring system with unlicensed personnel trained to report dysrhythmias to medical-surgical nurses with minimal training in caring for patients with dysrhythmias. The addition of telemetry beds would drastically increase revenue. The project would cut staffing costs and become the new model for telemetry monitoring for critical care units in the future. The nurses on the unit would take the verbal report from the staff monitoring the patients remotely and treat dysrhythmias using standing orders. Although the screen on the patient telemetry monitor was small, the nurse could not review the electrocardiogram event the unlicensed personnel reported to them.  It was in real-time for monitoring. The medical-surgical nurses lacking proper training would take the word of the monitor watchers. The nursing administrator asked the assistant administrator to stay quiet about the telemetry system hidden from a Joint Commission inspection.  (The wiring for the system and antennas were hidden in the ceiling above the ceiling tiles). The roll-out of the project would occur after their inspection was completed. The assistant nurse discussed with the administrator that the project was unsafe and could result in patient deaths because unlicensed personnel could incorrectly identify a dysrhythmia and the ill-prepared staff nurses had no way to review the dysrhythmia and could incorrectly treat the patient resulting in death. The nursing administrator backed by others (risk management lawyer, and other hospital administrators with business degrees) wanted to go on with the project. The assistant administrator went to the Nursing Practice Council and reported the situation to help stop it. The assistant nursing administrator became a whistle-blower to the Federal Government about the situation. The true story had an unfortunate ending. The Whistleblower legislation to fully protect the nurse and patients in patient-related situations was not yet enacted. Whistleblower laws at the time dealt with Medicare and Medicaid fraud. The nursing administrator was fired for not implementing the project as directed by their superior.  The nurse testified under witness protection and provided a video deposition and presented sufficient evidence resulting in the revocation of the nursing administrator's license and jail sentence since several patients died as the nursing administrator implemented the project. The hospital blamed the deaths on cell phone interference with the telemetry leading to misdiagnosis and treatment. Their alibi unfounded by the manufacturer of the monitors helped to decrease Public outrage and lawsuits. The hospital banned the usage of cell phones on telemetry units to prevent the issue in the future. The project was dismantled and nurses received adequate training to treat their patients in the future. 

Fortunately, the current Whistleblower legislation protects patients and nurses, and the state and Federal Government can stop illegal, unethical actions before patients die. Whistleblower legislation protects the employee from retaliation from their employer for enacting the whistleblower.  Things About Whistleblowing available from the American Nurses Association may provide you with additional information 

As a nursing leader, how does unionization protect nursing employees? If there is a dispute between yourself as a nurse manager and one of your staff nurses, how will the union fairly represent the staff nurse and you as nurse management at a dispute hearing? The nursing union represents both nursing staff nurses and nursing management. Explore the topic further in your assigned reading.

Finally, with the recent use of artificial intelligence, what are the ethical and legal ramifications of using it in nursing practice? When is it acceptable for improving patient care, and when does it cross the line in important decision-making for care? What do you as a nursing leader need to know to make a decision to write a policy on its use? In the assigned reading is an interesting article to help get you started on the topic.

Advance Directives

One very difficult ethical issue surrounds end of life decision-making. Legal issues are different in each state.  A nurse must know the laws in the state of practice.  See attached for links to state websites.

Kentucky Living willsLinks to an external site.

Ohio Advance directivesLinks to an external site.

Indiana Advance DirectivesLinks to an external site.

The law has many different facets to legal and ethical issues.  Review Power Point below for additional information

Advance Directives Hierarchy to Decision Making.pptx  Download Advance Directives Hierarchy to Decision Making.pptx

Legal Issues in Nursing-3 (1).pptx  Download Legal Issues in Nursing-3 (1).pptx

                                                                                 References

American Nurses Association. (2015).   The Code of Ethics for Nurses.

       Retrieved from :   https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/Links to an external site. . 

Belcik, K. D. (2022).  Leadership and Management of Nursing Care. (K. Ernstmeyer & E. Christman, Eds.). Pressbooks.

       Retrieved from  https://pressbooks.txst.edu/nursinglm/Links to an external site  .

Douthit, B., Shaw, R., Lytle, K., Richesson, R., Cary, M. (2022). Artificial intelligence in nursing: Practical implementations in clinical

       settings.  American Nurse. Retrieved from:  https://www.myamericannurse.com/ai-artificial-intelligence-in-nursing/Links to an external site. . 

Marquis, B. L. & Huston, C. J. (2021).  Leadership roles and management functions in nursing: Theory and application. (10th ed.). Philadelphia:

       Lippincott Williams & Wilkins. Chapters 4, 5, 22.

Course Syllabus Student Learning Outcomes:

Upon completion of this course, the student will:

1. Explore the styles of nurse leaders in a variety of healthcare settings. SLO 1

2. Evaluate the roles of the nurse leaders, managers, and followers from a legal and ethical perspective. SLO 2

3. Identify principles of quality improvement, health care policy, and cost-effectiveness in the role of nurse leader. SLO 3

4. Evaluate the structure and culture of complex healthcare organizations. SLO 4

5. Critically analyze effective behaviors in solving leadership issues. SLO 5

6. Describe the effective communication skills needed to ensure quality care within a transdisciplinary team. SLO 6

Module 6 Student Learning Outcomes 

At the end of this Module 6, the student will be able to:

1. Use a systematic problem-solving or decision-making model to determine appropriate action for select ethical problems (COs 3 & 4)

2. Demonstrate self-awareness regarding the ethical frameworks and ethical principles that most strongly influence his or her personal decision-making (COs 3 & 4)

3. Correlate the legal authority of nursing practice and the nursing process (SLOs 3 & 4)

4. Describe the relationships between national economic prosperity, the existence of nursing shortages and surpluses, and the unionization rates of nurses (COs 3 & 4)

Content

Ethical decision making

Legal issues

Faculty-Led Video Module 6 Pointers

Required Reading:

Part V: Andresen, K & Swanson, C (2023) Leading the change in Health Systems: Strategies for RN BSN students.  University of West Florida Pressbooks

https://oercommons.org/courses/leading-change-in-health-systems-strategies-for-rn-bsn-students Links to an external site.

Read Chapters 5 and 6 in Leadership and Management. Belcik, K. D. (2022).  Leadership and Management of Nursing Care. (K. Ernstmeyer & E. Christman, Eds.). Pressbooks. Retrieved from  https://pressbooks.txst.edu/nursinglm/ Links to an external site.  .

Read: American Nurses Associaiton (No date). Practice and Advocacy: Nurses in the workforce.   https://www.nursingworld.org/practice-policy/workforce/ Links to an external site.  .

Optional Reading:

Reading: Read Chapters 4, 5, & 22 in the textbook Leadership Roles and Management Functions in Nursing by Marquis and Huston (2021). 

What is a Signature Assignment? Signature assignments are a culmination of knowledge to prove a student has met the student learning objectives for the specific course. Therefore, a signature assignment is denoted in each course. The signature assignment is used by the RN BSN program to demonstrate core competency as a program evaluation. A signature assignment is usually the last assignment in the course and holds the most weight on the final grade. A 78% is the minimal grade a student must achieve to pass a course. Because of the importance of this last assignment, a student must achieve a 78% or higher on the signature assignment in order to pass the course. This means that a student with an overall passing grade can still fail the course if the signature assignment is less than 78%.

Purpose:  Nursing leadership requires the nurse to wear many hats and manage many different issues.  This assignment will be a culmination of all you have learned in this course.  You will explore your leadership style, roles as a leader, conflict management, patient assignment, change agent, and conflict management.  The AI discussion will allow you to apply the content you learned to an ethical situation.  You are to ask questions by applying nursing standards, ethical principles and leadership principles.  Your paper will reflect on your conversation and demonstrate an understanding of the concepts. 

Task:

Create a scenario using AI as a coach to develop a reflection using an ethical situation.

Choose an ethical situation from the following:

1. In a pandemic situation, who receives a ventilator - the 50 yo man without any chronic health condition, non smoker, non drinker or the 16 yo boy who vapes and has asthma?

2.  A fertility patient who has been trying for years finally conceives and is pregnant with four embryos. She wants a selective abortion to reduce to twins. Should the risk of losing all four be taken on a patient that has had fertility issues?

3. A three year old child is diagnosed with a disease that will require multiple human donations (blood, bone marrow etc.)  Should a sibling be forced to donate at the request of the parents?

Copy the following prompt to help start the conversation and paste in AI:  

You are a helpful friendly coach helping a nurse reflect on an ethical dilemma (Insert topic here) Introduce yourself. Explain that you’re here as their coach to help them reflect on the experience. Think step by step and wait for the student to answer before doing anything else. Do not share your plan with students. Reflect on each step of the conversation and then decide what to do next. Ask only 1 question at a time. 1. Ask the student to think about the experience and name 1 challenge that they overcame and 1 challenge that they did not overcome. Wait for a response. Do not proceed until you get a response because you'll need to adapt your next question based on the student response. 2. Then ask the student: Reflect on these challenges. How has your understanding of yourself as professional changed? What new insights did you gain? Do not proceed until you get a response. Do not share your plan with students. Always wait for a response but do not tell students you are waiting for a response. Ask open-ended questions but only ask them one at a time. Push students to give you extensive responses articulating a reflection of the situation. Ask them what led to their new insight. These questions prompt a deeper reflection. Push for specific examples. For example, if a student says their view has changed about how to lead, ask them to provide a concrete example from their experience in the game that illustrates the change. Specific examples anchor reflections in real learning moments. Discuss obstacles. Ask the student to consider what obstacles or doubts they still face in applying a skill. Discuss strategies for overcoming these obstacles. This helps turn reflections into goal setting. Next ask questions regarding nursing standards of practice and ethical principles. Wrap up the conversation by praising reflective thinking. Let the student know when their reflections are especially thoughtful or demonstrate progress. Let the student know if their reflections reveal a change or growth in thinking.

Keep the conversation going until AI lets you know they are available for further discussion.   Copy the link and paste to a word document.

Next, answer the following questions: ( Do not use the questions as headings, they are only prompts.  Use APA 7th edition with a title page and reference page.  Your references should include a textbook and ANA website)

 answer the following questions:

1. What ethical principles can you identify that were discussed in your conversation?

2. List and explain the standards of nursing practice that were discussed.

3. How can you use this information in your nursing practice?

4. Reflect on your own leadership style and personality. What barriers would you have to engaging in a conversation such as the one portrayed with a real coworker?

5. How has this experiment changed the way you think about conflict management? Would you make any changes to your approach with conflict managment?

Submit:

1. Paper that includes the answers to the above five questions and the link for your AI conversation.  (see template)

2. Virtual simulation cumulative report. 

Signature Assignment template.docx  Download Signature Assignment template.docx

Rubric

NRP 477 Rubric for signature assignment

Total Points: 310

Module 6- Foundation for Effective Leadership and Management in Ethics and the Law-2

 Introduction:  Foundation for Effective Leadership and Management in Ethics and the Law (SLOs 1,2,3,4,5,6)

Exploring Ethics and Law in Leadership:

The professional nurse has the American Nurses Association (ANA) Code of Ethics to guide our ethical behavior. As a nurse, your first priority is your patient. You have explored in other courses the ethical implications of nursing practice.  You have learned how to deal with ethical dilemmas, and who to go to for help using the chain of command. During this module, explore your required reading from the perspectives of nursing leadership. What do you do as a nurse acting as a charge nurse or in nursing management to remain a role model for ethical behavior to your staff and interdisciplinary team members? What should a nurse leader do when facing an ethical dilemma? Who does the nursing leader go to to help with such a dilemma? What should a nursing leader do when another nursing leader is unethical in their behavior? What if the leader is your superior?  (Just as you feel uncomfortable with the thoughts of dealing with your superior displaying unethical behavior, if you let your guard down and display such, your staff are in a predicament to deal with your behavior). 

Personally reflect on how your moral compass affects your ethical decision-making. What can you do as a leader to prevent moral distress? 

As you read the required reading, determine the legal ramifications of being a nursing leader. When would there be situations in which as a leader, you have to become the whistleblower to protect the patients over the actions of the place you are currently practicing? In your place of practice, what process should you take before blowing the whistle? What actions can quickly protect the patients before an improper action would lead to disaster?  For example, an assistant nursing administrator was asked to implement a new project: A remote patient telemetry monitoring system with unlicensed personnel trained to report dysrhythmias to medical-surgical nurses with minimal training in caring for patients with dysrhythmias. The addition of telemetry beds would drastically increase revenue. The project would cut staffing costs and become the new model for telemetry monitoring for critical care units in the future. The nurses on the unit would take the verbal report from the staff monitoring the patients remotely and treat dysrhythmias using standing orders. Although the screen on the patient telemetry monitor was small, the nurse could not review the electrocardiogram event the unlicensed personnel reported to them.  It was in real-time for monitoring. The medical-surgical nurses lacking proper training would take the word of the monitor watchers. The nursing administrator asked the assistant administrator to stay quiet about the telemetry system hidden from a Joint Commission inspection.  (The wiring for the system and antennas were hidden in the ceiling above the ceiling tiles). The roll-out of the project would occur after their inspection was completed. The assistant nurse discussed with the administrator that the project was unsafe and could result in patient deaths because unlicensed personnel could incorrectly identify a dysrhythmia and the ill-prepared staff nurses had no way to review the dysrhythmia and could incorrectly treat the patient resulting in death. The nursing administrator backed by others (risk management lawyer, and other hospital administrators with business degrees) wanted to go on with the project. The assistant administrator went to the Nursing Practice Council and reported the situation to help stop it. The assistant nursing administrator became a whistle-blower to the Federal Government about the situation. The true story had an unfortunate ending. The Whistleblower legislation to fully protect the nurse and patients in patient-related situations was not yet enacted. Whistleblower laws at the time dealt with Medicare and Medicaid fraud. The nursing administrator was fired for not implementing the project as directed by their superior.  The nurse testified under witness protection and provided a video deposition and presented sufficient evidence resulting in the revocation of the nursing administrator's license and jail sentence since several patients died as the nursing administrator implemented the project. The hospital blamed the deaths on cell phone interference with the telemetry leading to misdiagnosis and treatment. Their alibi unfounded by the manufacturer of the monitors helped to decrease Public outrage and lawsuits. The hospital banned the usage of cell phones on telemetry units to prevent the issue in the future. The project was dismantled and nurses received adequate training to treat their patients in the future. 

Fortunately, the current Whistleblower legislation protects patients and nurses, and the state and Federal Government can stop illegal, unethical actions before patients die. Whistleblower legislation protects the employee from retaliation from their employer for enacting the whistleblower.  Things About Whistleblowing available from the American Nurses Association may provide you with additional information 

As a nursing leader, how does unionization protect nursing employees? If there is a dispute between yourself as a nurse manager and one of your staff nurses, how will the union fairly represent the staff nurse and you as nurse management at a dispute hearing? The nursing union represents both nursing staff nurses and nursing management. Explore the topic further in your assigned reading.

Finally, with the recent use of artificial intelligence, what are the ethical and legal ramifications of using it in nursing practice? When is it acceptable for improving patient care, and when does it cross the line in important decision-making for care? What do you as a nursing leader need to know to make a decision to write a policy on its use? In the assigned reading is an interesting article to help get you started on the topic.

Advance Directives

One very difficult ethical issue surrounds end of life decision-making. Legal issues are different in each state.  A nurse must know the laws in the state of practice.  See attached for links to state websites.

Kentucky Living willsLinks to an external site.

Ohio Advance directivesLinks to an external site.

Indiana Advance DirectivesLinks to an external site.

The law has many different facets to legal and ethical issues.  Review Power Point below for additional information

Advance Directives Hierarchy to Decision Making.pptx  Download Advance Directives Hierarchy to Decision Making.pptx

Legal Issues in Nursing-3 (1).pptx  Download Legal Issues in Nursing-3 (1).pptx

                                                                                 References

American Nurses Association. (2015).   The Code of Ethics for Nurses.

       Retrieved from :   https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/Links to an external site. . 

Belcik, K. D. (2022).  Leadership and Management of Nursing Care. (K. Ernstmeyer & E. Christman, Eds.). Pressbooks.

       Retrieved from  https://pressbooks.txst.edu/nursinglm/Links to an external site  .

Douthit, B., Shaw, R., Lytle, K., Richesson, R., Cary, M. (2022). Artificial intelligence in nursing: Practical implementations in clinical

       settings.  American Nurse. Retrieved from:  https://www.myamericannurse.com/ai-artificial-intelligence-in-nursing/Links to an external site. . 

Marquis, B. L. & Huston, C. J. (2021).  Leadership roles and management functions in nursing: Theory and application. (10th ed.). Philadelphia:

       Lippincott Williams & Wilkins. Chapters 4, 5, 22.

Course Syllabus Student Learning Outcomes:

Upon completion of this course, the student will:

1. Explore the styles of nurse leaders in a variety of healthcare settings. SLO 1

2. Evaluate the roles of the nurse leaders, managers, and followers from a legal and ethical perspective. SLO 2

3. Identify principles of quality improvement, health care policy, and cost-effectiveness in the role of nurse leader. SLO 3

4. Evaluate the structure and culture of complex healthcare organizations. SLO 4

5. Critically analyze effective behaviors in solving leadership issues. SLO 5

6. Describe the effective communication skills needed to ensure quality care within a transdisciplinary team. SLO 6

Module 6 Student Learning Outcomes 

At the end of this Module 6, the student will be able to:

1. Use a systematic problem-solving or decision-making model to determine appropriate action for select ethical problems (COs 3 & 4)

2. Demonstrate self-awareness regarding the ethical frameworks and ethical principles that most strongly influence his or her personal decision-making (COs 3 & 4)

3. Correlate the legal authority of nursing practice and the nursing process (SLOs 3 & 4)

4. Describe the relationships between national economic prosperity, the existence of nursing shortages and surpluses, and the unionization rates of nurses (COs 3 & 4)

Content

Ethical decision making

Legal issues

Faculty-Led Video Module 6 Pointers

Required Reading:

Part V: Andresen, K & Swanson, C (2023) Leading the change in Health Systems: Strategies for RN BSN students.  University of West Florida Pressbooks

https://oercommons.org/courses/leading-change-in-health-systems-strategies-for-rn-bsn-students Links to an external site.

Read Chapters 5 and 6 in Leadership and Management. Belcik, K. D. (2022).  Leadership and Management of Nursing Care. (K. Ernstmeyer & E. Christman, Eds.). Pressbooks. Retrieved from  https://pressbooks.txst.edu/nursinglm/ Links to an external site.  .

Read: American Nurses Associaiton (No date). Practice and Advocacy: Nurses in the workforce.   https://www.nursingworld.org/practice-policy/workforce/ Links to an external site.  .

Optional Reading:

Reading: Read Chapters 4, 5, & 22 in the textbook Leadership Roles and Management Functions in Nursing by Marquis and Huston (2021). 

What is a Signature Assignment? Signature assignments are a culmination of knowledge to prove a student has met the student learning objectives for the specific course. Therefore, a signature assignment is denoted in each course. The signature assignment is used by the RN BSN program to demonstrate core competency as a program evaluation. A signature assignment is usually the last assignment in the course and holds the most weight on the final grade. A 78% is the minimal grade a student must achieve to pass a course. Because of the importance of this last assignment, a student must achieve a 78% or higher on the signature assignment in order to pass the course. This means that a student with an overall passing grade can still fail the course if the signature assignment is less than 78%.

Purpose:  Nursing leadership requires the nurse to wear many hats and manage many different issues.  This assignment will be a culmination of all you have learned in this course.  You will explore your leadership style, roles as a leader, conflict management, patient assignment, change agent, and conflict management.  The AI discussion will allow you to apply the content you learned to an ethical situation.  You are to ask questions by applying nursing standards, ethical principles and leadership principles.  Your paper will reflect on your conversation and demonstrate an understanding of the concepts. 

Task:

Create a scenario using AI as a coach to develop a reflection using an ethical situation.

Choose an ethical situation from the following:

1. In a pandemic situation, who receives a ventilator - the 50 yo man without any chronic health condition, non smoker, non drinker or the 16 yo boy who vapes and has asthma?

2.  A fertility patient who has been trying for years finally conceives and is pregnant with four embryos. She wants a selective abortion to reduce to twins. Should the risk of losing all four be taken on a patient that has had fertility issues?

3. A three year old child is diagnosed with a disease that will require multiple human donations (blood, bone marrow etc.)  Should a sibling be forced to donate at the request of the parents?

Copy the following prompt to help start the conversation and paste in AI:  

You are a helpful friendly coach helping a nurse reflect on an ethical dilemma (Insert topic here) Introduce yourself. Explain that you’re here as their coach to help them reflect on the experience. Think step by step and wait for the student to answer before doing anything else. Do not share your plan with students. Reflect on each step of the conversation and then decide what to do next. Ask only 1 question at a time. 1. Ask the student to think about the experience and name 1 challenge that they overcame and 1 challenge that they did not overcome. Wait for a response. Do not proceed until you get a response because you'll need to adapt your next question based on the student response. 2. Then ask the student: Reflect on these challenges. How has your understanding of yourself as professional changed? What new insights did you gain? Do not proceed until you get a response. Do not share your plan with students. Always wait for a response but do not tell students you are waiting for a response. Ask open-ended questions but only ask them one at a time. Push students to give you extensive responses articulating a reflection of the situation. Ask them what led to their new insight. These questions prompt a deeper reflection. Push for specific examples. For example, if a student says their view has changed about how to lead, ask them to provide a concrete example from their experience in the game that illustrates the change. Specific examples anchor reflections in real learning moments. Discuss obstacles. Ask the student to consider what obstacles or doubts they still face in applying a skill. Discuss strategies for overcoming these obstacles. This helps turn reflections into goal setting. Next ask questions regarding nursing standards of practice and ethical principles. Wrap up the conversation by praising reflective thinking. Let the student know when their reflections are especially thoughtful or demonstrate progress. Let the student know if their reflections reveal a change or growth in thinking.

Keep the conversation going until AI lets you know they are available for further discussion.   Copy the link and paste to a word document.

Next, answer the following questions: ( Do not use the questions as headings, they are only prompts.  Use APA 7th edition with a title page and reference page.  Your references should include a textbook and ANA website)

 answer the following questions:

1. What ethical principles can you identify that were discussed in your conversation?

2. List and explain the standards of nursing practice that were discussed.

3. How can you use this information in your nursing practice?

4. Reflect on your own leadership style and personality. What barriers would you have to engaging in a conversation such as the one portrayed with a real coworker?

5. How has this experiment changed the way you think about conflict management? Would you make any changes to your approach with conflict managment?

Submit:

1. Paper that includes the answers to the above five questions and the link for your AI conversation.  (see template)

2. Virtual simulation cumulative report. 

Signature Assignment template.docx  Download Signature Assignment template.docx

Rubric

NRP 477 Rubric for signature assignment

Total Points: 310