NURS-3375: Health Policy And Legal Aspect Essay
NURS-3375: Health Policy And Legal Aspect Essay
Module 3: Reflection Assignment – Peer Review
Submit by 2359 (CT) Saturday of Module 3.
Name:
Date:
Overview: Peer Review
In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.NURS-3375: Health Policy And Legal Aspect Essay.
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ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPELTE BOTH PARTS.
Refer to your course readings and lectures as you complete the assignment.
Performance Objectives:
· Apply the Minor Incident Rule to specific incidents.
· Describe the due process protections for a nurse who is peer-reviewed.
Rubric
Use this rubric to guide your work on the assignment, “Peer Review.”
Task
Accomplished
Proficient
Needs Improvement
Part 1 (a) Applying Rule 217.16 (Total 50 points)
Lists all the correct 5 criteria, accurately explains application of criteria clearly. (25 points)
Lists 3 or 4 of the correct criteria, accurately explains application of these criteria (15 points)
Lists 2 applications of criteria. 10 points)
Incorrectly lists criteria (0 point)
Part 1 (b) Reflects upon applications of Rule 217.16 (Total 25 points)
Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)
Correctly states if nurse should be reported or not reported with 2 sentences. (15 point)
Writes 1 sentence. (10 points)
Incorrectly judges whether violations occurred (0 point)
Part 2
Violation of IBPR Rule 217.19 (Total 25 points)
Correctly listed the 4 violations and provides correct explanations (25 points)
Correctly lists 2-3 violations and explanations (15 points)
Lists 1 violation and explanation (10 points)
Incorrectly lists criteria (0 point)
Part 3
Multiple choice and true/false questions- 5 points each
(Total 25 points)
All 5 questions correct (25 points)
4 questions correct (20 points)
3 questions correct (15 points)
2 questions correct (10 points)
1 question correct (5 points)
0 questions correct (0 point)
Part 1: (a) Applying Rule 217.16(h) Minor Incidents
Read the following scenario and then answer the questions that follow
You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.NURS-3375: Health Policy And Legal Aspect Essay.
Should Nurse A be reported to the BON?
Let’s review what deems a minor vs. a reportable (NOT minor) incident-
A minor incident is- 217.16(a)- as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.
A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.
Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp
Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.
Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.NURS-3375: Health Policy And Legal Aspect Essay.
Criteria that determine an incident is reportable
Rule 217.16(h)
Explanation of whether or not Nurse A’s actions are minor vs. reportable
1. Conduct that ignores a substantial risk that exposed a patient or other person to significant physical emotional or financial harm or the potential for such harm
2. Conduct that violates the Texas Nursing Practice Act or a Board rule and contributed to the death or serious injury of a patient
3. A practice related violation involving impairment or suspected impairment by reason of chemical dependency, intemperate use, misuse or abuse of drugs or alcohol, mental illness, or diminished mental capacity
The nurse was not impaired by reason of chemical dependency, mental illness or diminished mental capacity therefore should not have been reported
4. A violation of Board Rule 217.12 with actions that constitute abuse, exploitation, fraud, or a violation of professional boundaries
5. Actions that indicate the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse’s continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior
Part 1: (b) Report vs. Not Report
Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.
Part 2: Applying Rule 217.19 Incident-Based Peer Review
Read the following scenario and then reflect upon the actions it portrays.
Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.”
You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”
Applying Rule 217.19, what violations of the rule occurred in the above scenario?
First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from). In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at
Which part of the rule was violated?
(Subsection number and letter OR descriptive phrase)
(Rule 217.19)
Explanation of violation
1.
2.
3.
4.
Submitting Your Assignment:
· Click the word Assignment in the Module.
· Click on the words Module 3 Assignment. The assignment submission document will open.
· Go to 2. Assignment Materials-Submission. Click Browse and navigate to your Desktop where you saved your paper. Select the final version of your paper to upload from your computer.NURS-3375: Health Policy And Legal Aspect Essay.
· When you’ve selected your paper, click Attach Files and your saved assignment document should appear in the submission box just above the Attach Files button.
· Click Submit at the bottom of the Assignment Submission screen and your saved document assignment will appear the gradebook with a green exclamation point that alerts your Academic Coach that your assignment is ready for grading.NURS-3375: Health Policy And Legal Aspect Essay.
Each week you will make an entry into your Journal. You are asked to reflect on 3 of the key points for each class. Key points: What did you take away from the module knowledge wise or interesting? Each entry should reflect on your understanding of the topic, your experiences and observations in your work environment or general nursing environment regarding the module topic.NURS-3375: Health Policy And Legal Aspect Essay.
This is a cumulative document. You will save it to your own computer desktop or memory device and update it each week. You may choose to record more than one entry each week, especially if you have an “aha!” moment as a result of your reading, discussions, or experience. You will upload and submit the latest version of your Health Policy & Legal Aspects Reflective Journal to Blackboard by 2359 the Saturday following each class of this course. It is not necessary that your entries be formatted or written in any particular way because it is for your benefit. Your entries will only be reviewed to ensure that you are making sufficient progress and thinking deeply about the requirements in the course.NURS-3375: Health Policy And Legal Aspect Essay.
Rubrics:
Use this rubric to guide your Journal entries.
There will be total of 3 Journal entries. With each journal you are expected to address 3 key points from the class lecture, discussion, and content, discuss how each point applies to your practice as a nurse, and, finally, how will your practice change in the future because of this information.
Journal Rubric for each Module
Criteria Target Unacceptable
1st Key Point
(30 Points)
Discuss 1st key point and why it is important or memorable. Connect RN-BSN experiences to key point (career goals, prior nursing practice, a previous RN BSN course, nursing theories or research). Describes how personal practice will be different in the future based on RN-BSN program as a result of the key point addressed.NURS-3375: Health Policy And Legal Aspect Essay.
(30 Points)
Does not sufficiently record connections or reflections. Fails to connect RN-BSN experiences to goals, prior nursing practice, coursework, theories or research to key areas addressed. Fails to describe how personal practice will be different in the future based on RN-BSN program.NURS-3375: Health Policy And Legal Aspect Essay.
(0 Points)
2nd Key Point
(30 Points)
Discuss 2nd key point and why it is important or memorable. Connect RN-BSN experiences to key point (career goals, prior nursing practice, a previous RN BSN course, nursing theories or research). Describes how personal practice will be different in the future based on RN-BSN program as a result of the key point addressed.
(30 Points)
Does not sufficiently record connections or reflections. Fails to connect RN-BSN experiences to goals, prior nursing practice, coursework, theories or research to key areas addressed. Fails to describe how personal practice will be different in the future based on RN-BSN program.
(0 points)
3rd Key Point
(30 Points)
Discuss 3rd key point and why it is important or memorable. Connect RN-BSN experiences to key point (career goals, prior nursing practice, a previous RN BSN course, nursing theories or research). Describes how personal practice will be different in the future based on RN-BSN program as a result of the key point addressed.
(30 Points)
Does not sufficiently record connections or reflections. Fails to connect RN-BSN experiences to goals, prior nursing practice, coursework, theories or research to key areas addressed. Fails to describe how personal practice will be different in the future based on RN-BSN program.NURS-3375: Health Policy And Legal Aspect Essay.
(0 points)
Spelling & Grammar
(10 points)
3 or less spelling & grammar errors in the reflective journal.
(10 Points)
Greater than 3 spelling & grammar errors in the reflective journal.
(0 Points)
Instructions:
Each week, record your experiences, connections to your course goals, and reflections as they relate to the given prompts and/or your course project. You must record one entry each week, but may record more (insert rows as needed). You may find it helpful and rewarding to record one entry at the beginning of the week, think about the prompt during the week, and then record another at the end of the week. For privacy, refer to patients, online colleagues, and/or co-workers with initials instead of names. Remember you must support your key points with cited references.NURS-3375: Health Policy And Legal Aspect Essay.
Save this document to your own computer desktop or storage device after each entry to create a cumulative journal.
Journal Entries
A separate Journal entry is required for each class by 2359 Saturday of each indicated class. Provide details of your thinking, including insights, challenges, paradigm shifts, and goals. Identify previous course topics, readings, or research that relate to the prompt.
Journal Entry
Reflective Journal Example: Identify 3 key points from this module. Reflect on how why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.
Place Key Point in this column: Reflect on the Key Point (following Journal Rubric) in this column:
YOU MUST ANSWER ALL 3 QUESTIONS ABOUT YOUR KEY POINT IN ORDER TO RECEIVE CREDIT (NO PARTIAL CREDIT). PLEASE COME UP WITH YOUR OWN KEY POINTS FOR EACH MODULE.
DELEGATION, SAFE HARBOR & PEER REVIEW ARE JUST EXAMPLES-PLEASE COME UP WITH YOUR OWN KEY POINTS FOR EACH MODULE.
Key Point 1:
Example:
Delegation
Why it is important: at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice: at least 3-4 well written sentences using critical thinking
How will I change my practice: at least 3-4 well written sentences using critical thinking
Key Point 2:
Example:
Safe Harbor
Why it is important: at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice: at least 3-4 well written sentences using critical thinking
How will I change my practice: at least 3-4 well written sentences using critical thinking
Key Point 3:
Example:
Peer Review
Why it is important: at least 3-4 well written sentences using critical thinking
How does it impact my work/nursing practice: at least 3-4 well written sentences using critical thinking
How will I change my practice: at least 3-4 well written sentences using critical thinking
Reflective Journal Module 2: Legal Overview and Peer Review Process. Identify 3 key points from this module. Reflect on how why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.
Place Key Point in this column: Reflect on the Key Point (following Journal Rubric) in this column:
Key Point 1: Safe Harbor Why it is important: Safe Harbor is a tool which can be used by nurses within the parameters of their job. It is important to fully understand these parameters so that this tool can be adequately, successfully, and efficiently used.
How does it impact my work/nursing practice: Safe Harbor allows nurses to have a form of recourse should they be presented with unsafe nursing practices. It ensures that the proper guidelines are followed so that patient’s safety is not affected.
How will I change my practice: As a nurse, and especially charge nurse, I need to be more aware and well versed of all legalities that protect nurses in instances of unsafe assignments. As a charge nurse, I will can advocate for my nurses with more substantiated knowledge.
Key Point 2 Unprofessional nursing conduct. Why it is important: As a charge nurse, I have encountered nurse staff that conduct themselves in an unprofessional manner. Therefore, I need tools and resources that I can provide to them to prove that they are indeed performing their duties in an unprofessional manner.
How does it impact my work/nursing practice: In my experience, on our unit, we have provide private rooms and semi-private rooms. In this particular case, I have had to address a situation in which a patient in a semi private room requested to make a formal complaint on a nurse aid who mishandled his duties while bathing her roommate who was an altered mental status patient.NURS-3375: Health Policy And Legal Aspect Essay.
How will I change my practice: When I need to write up a staff member in these cases, I will be well versed on the Texas Administrative Code Title 22 Part 11 Chapter 217 rule 217.12, which clearly states:
“Causing or permitting physical, emotional or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority and/or licensing board.”
Using this tool, I will be able to better help my nurses understand the parameters of the job and why it’s so important to always do the right thing.
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Key Point 3
Standard of nurse practice.
Why it is important: To have a standard of nursing practice is important so that regardless of where or when a patient is seen, the level of nursing care stays constant and consistent.
How does it impact my work/nursing practice: On our unit, we have license vocational nurses who work side by side with registered nurses on a cardiac unit. As the charge nurse, I have had to ensure that LVN’s are following their standards of care specific to vocational nurses and the RN’s are resourcing closely with their LVN’s. On a daily basis, I have to ensure the LVN’s are taking patients that are within their scope of practice. Examples are initiating certain cardiac medication drips and admissions of newly admitted stroke patients.NURS-3375: Health Policy And Legal Aspect Essay.
“(B) Shall assign specific tasks, activities and functions to unlicensed personnel commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and shall maintain appropriate supervision of unlicensed personnel.”
How will I change my practice: My knowledge of the specific tasks and who is responsible for them is essential to my ability to provide the best leadership, as charge nurse. Understanding what role and to what standard we are being held is also essential for providing the best, safest, and most efficient level of patient care.
Standards of Nursing Practice, Title 22, Part 11, Texas Administrative Code, Rule §217.11 (2007).
Reflective Journal Module 3: More Peer-Review Laws and Rules. Identify 3 key points from this module. Reflect on how why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.
Place Key Point in this column: Reflect on the Key Point (following Journal Rubric) in this column:
Key Point 1
Reporting minor incidents
Why it is important: I feel as if the Texas BON has the minor incident rule to protect the patients not to discipline the nurses. Reporting minor incidents is useful tool to monitor nurses and their progress in the clinical field. I have a lot of new nurses come through my floor. If they make a mistake due to inexperience this law protects their license. These events can be reported and then addressed immediately not only to prevent it happens again but to educate the nurse.
How does it impact my work/nursing practice: My floor is mainly made up of new nurses including new graduate nurses, new nurses to the telemetry field, and nurses from other countries. In my personal opinion, my mentality has always been to simply educate these nurses on how to safely perform tasks that are expected of them. If an error is made and there is a pattern, then reporting the incidents would be the proper way to handle the case of the event. Then it is escalated to a peer review for them to determine if the nurse is a harm to their patients.
How will I change my practice: After reading through this module, I have learned that it is my duty to report any incidents that may cause harm to the patients. In the four years that I have been a charge nurse, I never saw myself having to report anyone. We have many so many new nurses that normally the offense is corrected and not made again. But now after learning what reporting a minor incident means, the goal would not be to punish the nurse, but to protect the public from possible harm. If a nurse makes a mistake, then let’s correct that behavior. Reporting minor incidents will only help keep track of the nurse and to help monitor unsafe conduct.
Key Point 2 incident based peer review Why it is important: the main goal for incident based peer reviews is to maintain patient safety and the outcomes of the patients. Standards of care are maintained by holding nurses accountable in their own safe practices. But at times we need to hold the hospital and their units accountable for enabling unsafe situations. This is a learning tool for all involved in patient care.
How does it impact my work/nursing practice: We have always been taught that safety of the patient is priority in nursing. A scenario which is often introduced is the adequate staffing dilemma. On my floor if our staffing is not adequate then problems arise that might conflict with nurses being able to practice safely. Lack of the sufficient help such as running with one CNA for a thirty-six bed unit is all too common. This then causes a panic to my nurses which causes inadequately care for the patient and inevitably cause the patient harm. I have seen it over and over again where nurses have to cut corners just to make it through the day.NURS-3375: Health Policy And Legal Aspect Essay.
How will I change my practice: Becoming more familiar with what incident based peer reviews are, I will make it a point to report all events presented to me. This might lead to nurses being reported but my intention will not be to get my nurse in trouble but to either hold the hospital accountable should it be their fault or educate the nurse. I have seen that the majority of the time it is not due to their ignorance and lack of education but rather due to what the hospital has pushed on them. My hospital is notorious for pushing nurses to the brink to perform poorly and put patients at risk.NURS-3375: Health Policy And Legal Aspect Essay.
Key Point 3
Whistleblowing protections
Why it is important: As nurses we are taught to be patient advocates and how important our role is in the protecting and safety of our patients. But there is a stigma associated with being a “whistleblower,” therefore, many events are not being reported in the healthcare setting. Fortunately, the Texas BON nurse practice act rule217.19 offers whistleblower protections that basically protects nurses who report any situation they believe exposes a patient to harm are then protected from retaliation. It is important that we are protected and supported because our sole purpose is to be an advocate for our patients.
How does it impact my work/nursing practice: Although, there are whistleblower protections in place, where I work there are a lot of new nurses who are not well versed on this law. They are not confident in reporting what is right and what is wrong because they are just trying to make it through the day without making mistakes that are more likely due to their lack of experience. There is one nurse who has been in the field for twenty plus years and is constantly “complaining.” Per my director, she is considered “trouble.” I never follow up whether she actually does any formal reporting. My director doesn’t outright retaliate against her directly but she bad mouths this nurse to other staff members. I see that this in return does affect the newer nurses when wanting to speak up.NURS-3375: Health Policy And Legal Aspect Essay.
How will I change my practice: Being one of the veteran nurses, the newer nurses do come to me for advice on how to approach certain situations that they feel aren’t safe for their patients. I have built a rapport with my nurses. I see that they feel comfortable in reporting concerns that affect patient safety. But more often I see that they don’t want to make it a big deal may be due to possible retaliation. If I see that it needs to be escalated I then will bring it up to my director. By in my experience, I have learned how to bring certain situations to light without being labeled a “troublemaker.” For one, I have just recently started our own shared governance council, which I encourage the nurses to come forward to bring to light concerns they may have and make change on our unit. Fortunately, there has not been any major events that need to be escalated to the BON from my end.
Reflective Journal Module 4: Professional Boundaries and Challenges. Identify 3 key points from this module. Reflect on how why each point is important, how it impacts on your work experience or nursing practice, and how will you change your practice in the future based on each key area.
Place Key Point in this column: Reflect on the Key Point (following Journal Rubric) in this column:
Key Point 1 Why it is important:
How does it impact my work/nursing practice:
