National Nurses United

generation against the interest of patients and health care consumers. Independent Professional Responsibility to Act in the Exclusive Interests of Patients – Direct-Care RN Fiduciary Duty to Patients state nursing practice acts and Registered Nursing Board regulations, practice standards, and professional license guidelines generally impose a "fiduciary responsibility" on registered nurses who accept assignment to a direct-care RN-to-patient relationship in which nursing care is provided. The fiduciary obligation is to provide care in the exclusive interests of the patient without compromise or surrender to other interests, including the commercial, operational, revenue generation, or budgetary 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. Necessary Conditions for Safe, Therapeutic, Effective and Competent Registered Nursing Practice in the Interests of Patients protection of working and practice conditions for directcare RNs that are essential for safe, therapeutic, effective and competent nursing 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., numeric, unitbased RN-to-patient staffing ratios); (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 The 14 "Forces of Magnetism" FORCE 1: FORCE 2: FORCE 3: FORCE 4: FORCE 5: FORCE 6: FORCE 7: FORCE 8: FORCE 9: FORCE 10: FORCE 11: FORCE 12: FORCE 13: FORCE 14: APRIL 2010 Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality of Care Quality Improvement Consultation and Resources Autonomy Community and the Healthcare Organization Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development and revenue-generation interests and demands of the healthcare industry. Magnet Recognition and Replacement Technology to achieve and maintain "magnet" status, hospitals are required to demonstrate they have a mechanism in place which collects and analyzes patient outcome data with input from the nursing staff while incorporating clinical decision-making technologies. Hospitals seeking such designation have deployed these clinical technologies, which incorporate Computerized Physician Order Entry (CPOE) systems, computerized charting programs—including computerized medication charting—and decision-support technology, which is based on rigid standardization of the decision-making process of the direct care RN. RNs have a unique patient advocacy role in the health care delivery system and technology can only be used to augment this unique role. In analyzing the safe, therapeutic and effective values of any technology, RNs must be able to explore the potential of technology replacing human interaction in the delivery of patient care and the supplanting of critical thinking and independent clinical judgment with rigid clinical pathways or RN displacement and/or override technologies. Technology-driven care depersonalizes the RN relationship with her/his patients. Unfettered use of technology will have a chilling effect on the RN's ability to advocate in the exclusive interest of her/his patient. Undue reliance on technology can jeopardize the accuracy of diagnosis and treatment of patients. Such reliance will also create erosion of skills for the next generation of RNs who (unless stopped) will be trained in tasks instead of educated in skills. It has the potential of destroying the art and science of professional registered nursing. Human cognition is still superior to so-called "machine intelligence." One fact is certain: Computers and machines are only good for storing information; they cannot think critically as registered nurses do, nor are they capable of making split-second judgments in crisis intervention situations. Computers and machines are capable of quantifying data, but it will take a qualified RN to synthesize and interpret the data, otherwise it is meaningless. In order to be competitive in a market-driven healthcare system, "Magnet" recognition schemes have endorsed technologies that degrade skills, replace RNs, obliterate individual advocacy and avoid unions. The Healthcare Reality and Context of Magnet Hospital Recognition in response to the imperatives of capitation financing and consolidation of the hospital and health insurance industries over the past two decades, aided significantly by federal policies supporting economic concentration in HMO and provider markets, the hospital industry abandoned safe, therapeutic, effective and competent nursing care as an operational priority and restructured hospital nursing services to accommodate predominantly revenue-generation purposes. Key elements of this restructuring of hospital nursing care are a substantial cause of the current shortage of hospital direct-care registered nurses, including the following: (a) mass layoffs and permanent reductions in force of hospital direct-care registered nurses beginning in the early 1990's; 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 N AT I O N A L N U R S E 25

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