National Nurses United

CE 2_Nov REV 12/10/10 8:16 AM Page 26 nurses who accept assignment of a direct-care RN-to-patient relationship in which nursing care is provided. The fiduciary obligation infers a duty of loyalty to the patient to provide care in the exclusive interests of the patient without compromise or surrender to interests of health facility employers, physician practice groups, healthcare systems, managed care organizations, or health insurers/HMOs. The fiduciary relationship and related professional fiduciary duties of direct-care registered nurses to assigned patients are fundamental public health and safety regulations created to protect patient safety. The CNA/NNOC/NNU Code of RN Professional Responsibility the code of rn practice includes the following standards: 1. The nurse assumes responsibility and accountability for competent and appropriate performance of the RN Duty of Patient Advocacy, acting in the exclusive interests of the patient, as the patient's advocate, by initiating action to improve healthcare or to change decisions or activities which are against the interests or wishes of the patient, as circumstances may require, and by disclosing information and providing patient education as necessary for informed patient decisions about healthcare before care is provided to the patient. 2. The nurse recognizes the importance of collective patient advocacy to the public health and the integrity of professional nursing standards of care, and participates in necessary and appropriate actions and exercises of collective patient advocacy to protect the public health and safe patient care standards against erosion, restructuring, degradation, deregulation, and abolition by the large healthcare corporations, hospital chains, HMOs, insurance companies, pharmaceutical corporations, and other powerful economic institutions and interests which today seek to control the availability, access, and quality of healthcare services for purposes of profit and surplus revenue generation against the interests of patients and healthcare consumers. Necessary Conditions for Safe, Therapeutic, Effective, and Competent Registered Nursing Practice in the Interests of Patients protection of practice and working conditions for direct-care RNs that are essential for safe, therapeutic, effective, and competent care: 1. An RN-to-patient relationship which allows for competent performance of all aspects of the nursing process, enforced by objective minimum standards for safe patient care (i.e., specific, numeric unit-based RN-to-patient staffing ratios, with additional staffing up based upon the severity of illness/acuity of the patient). 2. The right and practical ability to exercise independent professional responsibility and judgment to determine and implement nursing care in the exclusive interests of patients, uncompromised by and without interference arising from the conflicting commercial and revenue-generating interests and demands of healthcare industry restructuring schemes. Hospital direct-care registered nursing practice today is severely burdened by excessive patient assignment loads, mandatory extend26 N AT I O N A L N U R S E ed work hours, unsafe patient handling practices, and routine exposure to risks of professional license discipline and/or malpractice liability inherent in the working and practice conditions created, implemented, and enforced by hospital administrators whose interests are aligned with the bottom line of the employer. Rounding and scripting schemes are a marketing gimmick used to promote a false appearance of superior hospital nursing practices and "quality" patient outcomes. They are a strategy used to gain market advantage for public and private reimbursement for hospital nursing services. These schemes promote a deceptive redesign of direct-care practice standards intended to restrain independent judgment and action by direct-care RNs, obstruct patient advocacy, and subvert the nursing process with a mandate to serve commercial enterprise interests over patient interests. What Then Shall We Do? consistent with the essential purposes of CNA/NNOC/NNU as the voice for direct-care RNs and the Code of Professional RN Practice adopted in the CNA/NNOC Bylaws, our position must be one of categorical rejection of scripting and rounding schemes that override the critical thinking and independent professional clinical judgment of the direct-care RN. The responsibility to act as a patient advocate in the exclusive interest of the patient, and the affirmative obligations of collective patient advocacy offers no opportunity for concession of that duty. Staff nurses must oppose any and all schemes that: Directly or indirectly interfere with or compromised direct-care RN professional responsibilities to provide care in the exclusive interests of patients and take all necessary and appropriate actions to ensure patient safety. Purport to replace or in effect operate to replace governmental regulation of hospital services for the public health and safety. Directly or indirectly coerce, intimidate, induce, or encourage frontline caregivers to accept assignments, duties, and responsibilities which require enterprise loyalty and/or apparent assumption of managerial or supervisory authority that would disqualify them from collective bargaining representation. Deceive and confuse direct-care RNs with Total Quality Management/Shared Governance/Rounding, Scripting, and Patient Satisfaction schemes, including pay-for-performance incentives to engage support for and suppress direct-care RN resistance to benchmarking schemes that redefine disease, treatment, and outcomes. Promote cutbacks that deprive patients of access to safe, therapeutic, effective, and competent direct-care nursing services through reductions in staff and nursing service budgets, prioritization of surplus revenue generation, and other anti-patient care practices under the cover of "gold standard" redesign and elimination of professional RN patient care standards. Fail to establish or allow for an objective, transparent process for working and practice conditions demonstrated to improve quality of the RN-patient therapeutic relationship, reduce errors and adverse outcomes, and improve RN recruitment and retention. Establish, sanction, or otherwise permit different standards of nursing service performance or patient care outcomes which allow for substandard or different classes of competent care in derogation of the universal health principle of a single standard of excellent care with equitable access to all. W W W. N A T I O N A L N U R S E S U N I T E D . O R G NOVEMBER 2010

• Cover