Oklahoma Nurse - May 2021

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14 The Oklahoma Nurse May, June, July 2021 EMERGING NURSES Is healthcare a right? Tina Edwards, MBA, MSN, RN WE NEED YOUR HELP! Charge Nurse, Full-time night position, RN or LPN needed immediately. Full-time Day, Full-time Night, PRN. Offering a $4,000 Sign-On Bonus Please apply at good-sam.jobs JOIN OUR TEAM AS A Public Health Nurse and make a difference in the lives of Oklahomans. u Licensed Practical Nurses u Registered Nurses u Nursing Managers u Advanced Practice Registered Nurses May be eligible for the NURSE CORPS LOAN REPAYMENT PROGRAM Find out more: jobs.ok.gov Filter by Agency g State Department of Health Statewide locations g competitive salary and benefits package (includes a generous benefits allowance) g paid time off g retirement g M-F, 8-5, off nights g weekends and holidays, etc. This was one of the discussion questions in my DNP-FNP program that really sparked my interest the more I researched it. I never realized, until that point, how many different opinions nurses have on this subject. I read several arguments saying healthcare was a privilege, some said it was a service, and some said it was a right. When I consider what a right is, I believe this is something that people cannot be denied. Rights are our principal standardizing rules for individuals' entitlement. A right, therefore, cannot be taken away, nor can it be dismissed. Did you know that neither the U.S. Constitution nor the Supreme Court elucidates that healthcare is a constitutional right for those who cannot afford it? But prisoners can have full access to medical care under the Supreme Court ruling. Do we really want granny to have to commit a crime in order to get a pacemaker? Do you see a problem with our healthcare system? Legally speaking, the right to healthcare incorporates a duty and obligation that includes everyone who enters a hospital seeking medical attention requires a health screening. In 1986, Congress passed "The Emergency Medical Treatment and Active Labor Act (EMTALA)," an act guaranteeing non-discriminatory access to emergency medical care and thus to the health care system (Zibulewsky J., 2001). Therefore, healthcare is a right to only those who seek emergency care. 1) Did you know that nurses account for over 20% of EMTALA violations? (Cohen, 2015) 2) Did you know that nurses can be held responsible under their state's Nurse Practice Act in medical malpractice lawsuits for EMTALA violations? (Cohen, 2015) 3) Do you feel that EMTALA should expand to Urgent care so that people do not seek emergency care for nonmedical emergencies? Because they 1) cannot afford it or 2) do not have insurance coverage. In closing, I believe we as nurses need to raise our voices and advocate that healthcare is a right! Not just for prisoners, not just for ER seekers, but for everyone. If we see that healthcare as a service or a privilege and not as a right, I believe we are undervaluing our profession in so many ways. References: Cohen, S. (2005). ED nurses are responsible for 20% of EMTALA violations: Don't be next. https://www. reliasmedia.com/articles/2102-ed-nurses-are- responsible-for-20-of-emtala-violations-don- 8217-t-be-next.-ed-nurses EMTALA – Healthcare. https://healthcare.uslegal.com/ treatment-witout-insurance-how-are-theuninsured-protected/emtala Health Care: Constitutional Rights and Legislative Powers. https://www.everycrs.report.com/reports/ R40846.html Zibulewsky, J (2001) The Emergency Medical Treatment and Active Labor Act (Emtala): What It Is and What It Means for Physicians, Baylor University Medical Center Proceedings, 14:4, 339-346, DOI: 10.1080/08998280.2001.11927785 Benefits include Health, Dental, Vision, and Retirement. Good Samaritan Society Liberal 620.624.3831 Questions? Call: 405-271-4171 HumanResources@health.ok.gov
May, June, July 2021 The Oklahoma Nurse 15 An Ethic of Justice Viewed through the Lens of an Ethic of Care: How Nurse Leaders May Combat Workplace Bullying Gloria Matthews, DNP, RN, CNL, CDE University of Oklahoma Medical Center Valerie Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A University of Oklahoma Health Sciences Center Fran & Earl Ziegler College of Nursing, Lawton Campus The purpose of this paper is to present integration of two ethical approaches to combat workplace bullying within a clinical setting from an advance nursing practice leadership perspective. A description of ethic of care and ethic of justice is presented and critically appraised as it relates to managing workplace bullying. The importance of the application of the ethic of justice through the lens of the ethic of care will be elucidated. Description and Application to Workplace Bullying A failure of nursing leadership to address workplace bullying demonstrates a lack of compassion and organizational injustice. Bullying is the repeated and persistent, abusive mistreatment by one or more perpetrators towards one or more victims that is marked by threatening, humiliating or intimidating conduct, work interference, or verbal abuse (Fink-Samnick, 2018). Bullying is a systemic problem and reflects behavior patterns and surreptitious characteristics of a culture of violence that contributes to various expressions and manifestations of violence within an organization (Smit & Scherman, 2016). The Joint Commission (2008) notes that intimidating and disruptive behaviors contribute to medical errors, poor patient and staff satisfaction, staff turnover and poor collaborative work environments. Ethic of Care The ethic of care is a moral approach characterized by contextual, holistic empathy and is based on caring, strengthening and maintaining interpersonal relationships. It emphasizes the importance of insight gained from being open and receptive to the realities and needs of others (Simola, 2003). The ethic of care aligns with the authentic, servant and transformational leaders who put followers’ interests above their own and influence followers through building relationships, developing a collective vision, and attending to the needs and growth of their followers (Groves & LaRocca, 2011). Most occurrences of bullying are learned behaviors directed by reactions to stress and organizational norms and, therefore, can be unlearned (Berry et al, 2016). Leaders guided by an ethic of care model take decisive action when confronted with behaviors that do not adhere to expected conduct. In combating workplace bullying, effective leaders are proficient in communication and competent in coaching, staff development, maintaining high standards of conduct, and fostering an environment of trust and mutual respect (Parker, Harrington, Smith, Sellers, and Millenbach, 2016). Bullying is an attempt to intimidate and gain power over someone else. Structural empowerment is an effective technique to mitigate the effects and incidents of bullying (Lachman, 2014). Effective nurse empowerment can be obtained through shared governance to minimize power imbalances and enhance shared responsibility and transparency in decision making (Berry et al, 2016; Parker et al, 2016). Skill development is an important weapon in the battle against bullying. Strategies such as cognitive rehearsal, skills-based training, and role-playing have been successful in raising staff awareness and combating bullying (Balevre, Balevre, & Chesire, 2018; Parker et al., 2016). Normative leadership models such as transformational, servant and authentic leadership constructively address the bullying by modeling an ethic of care perspective and seeking to facilitate followers’ self-actualization. The assumption is that ethical leadership styles promote social cohesion, professionalism, and empowerment (Webster, 2016). Ethic of Justice The ethic of justice is a moral approach that is characterized by justice, fairness, reciprocity and the protection of individual rights. Individuals demonstrate impartiality and the ability to reason abstractly through the application of formal, logical and impartial rules (Simola, 2003). The ethic of justice aligns with the transactional leader who influences followers by control, reward and corrective transactions (Groves & LaRocca, 2011). Structural empowerment is gained through establishment of an ethical infrastructure that reinforces ethical principles and behavioral expectations of members of the organization (Einarsen, Mykletun, Einarsen, Skogstad, & Salin, 2017). Aligned with the ethic of justice, organizations establish standardized policies, procedures and documents such as codes of ethics, procedures for handling complaints and zero tolerance policies (Einarsen et al., 2017). Hutchinson (2009) posits that rather than focusing on the individual, leaders should direct corrective measures towards the act of bullying itself and gain insight into work group and organizational factors that enable the behavior. The focus is on reintegration and restoration of social relationships within the context of a supportive group, such as a restorative circle, where the attention is placed on repairing harm rather than blame and punishment. Reflection on Integration of Ethical Approaches It is important for leaders to integrate the two ethical perspectives by distributing justice within a caring framework (Sorbello, 2008). Organizations and leaders must clarify and communicate that bullying is unacceptable. If corrective actions fail, termination is an acceptable consequence to continued behavior (Lee et al., 2014). At times, leaders must implement corrective actions and uphold values and policies set forth by the organization, but it is in the delivery and intent that determines a caring leader. Conclusion Combating bullying requires a multidimensional approach. By establishing a relationship-based ethics of care perspective, along with visible organizational-based regulatory sanctions in communication and ethic of justice, organizations can create and sustain a respectful working environment for the prevention of workplace bullying. The integration of the divergent ethical perspectives of an ethic of care and an ethic of justice provides an environment of collegiality, transparency and support for improved patientrelated and nurse-related outcomes. References Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018). Nursing professional development anti-bullying project. Journal for Nurses in Professional Development, 34(5), 277-282. https://doi. org/10.1097/NND.0000000000000470 Berry, P. A., Gillespie, G. L., Fisher, B. S., & Gormley, D. K. (2016). Recognizing, confronting, and eliminating workplace bullying. Workplace Health & Safety, 64(7), 337-341. https://doi.org/10.18291/njwls. v7i1.81398 Einarsen, K., Mykletun, R. J., Einarsen, S. V., Skogstad, A., & Salin, D. (2017). Ethical infrastructure and successful handling of workplace bullying. Nordic Journal of Working Life Studies, 7(1), 37–54. https://doi.org/10.18291/njwls. v7i1.81398 Fink-Samnick, E. (2018). The new age of bullying and violence in health care: part 4: managing organizational cultures and beyond. Professional Case Management, 23(6), 294–306. https://doi. org/10.1097/NCM.0000000000000324 Groves, K., & LaRocca, M. (2011). An empirical study of leader ethical values, transformational and transactional leadership, and follower attitudes toward corporate social responsibility. Journal of Business Ethics, 103(4), 511–528. https://doi. org/10.1007/s10551-011-0877-y Hutchinson, M. (2009). Restorative approaches to workplace bullying: Educating nurses towards shared responsibility. Contemporary Nurse, 32(1–2), 147–155. https://doi.org/10.5172/ conu.32.1-2.147 Lachman, V. D. (2014). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/ lateral violence. Medsurg Nursing, 23(1), 56-60. Parker, K. M., Harrington, A., Smith, C. M., Sellers, K. F., & Millenbach, L. (2016). Creating a nurseled culture to minimize horizontal violence in the acute care setting: A multi-interventional approach. Journal for Nurses in Professional Development, 32(2), 56-63. https://doi. org/10.1097/NND.0000000000000224 Simola, S. (2003). Ethics of justice and care in corporate crisis management. Journal of Business Ethics, 46(4), 351-361. https://doi. org/10.1023/A:1025607928196 Smit, B., & Scherman, V. (2016). A case for relational leadership and an ethics of care for counteracting bullying at schools. South African Journal of Education, 36(4), 1-9. http://www. sajournalofeducation.co.za/index.php/saje/ article/view/1312/668 Sorbello, B. (2008). The nurse administrator as caring person: A synoptic analysis applying caring philosophy, Ray’s ethical theory of existential authenticity, the ethic of justice, and the ethic of care. International Journal of Human Caring, 12(1), 44-49. 10.20467/1091-5710.12.1.44 The Joint Commission. (2008). Behaviors that undermine a culture of safety. (Sentinel Event Alert, Issue 40). http://www.jointcommission.org/assets/1 /18/SEA_40.pdf Webster, M. (2016). Challenging workplace bullying: the role of social work leadership integrity. Ethics & Social Welfare, 10(4), 316–332. https://doi.org/10 .1080/17496535.2016.1155633 Bridget.Bridger Ada, Oklahoma
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