Issue link: https://nnumagazine.uberflip.com/i/198516
CE:Final 5/27/08 11:58 AM Page 21 cy, acting in the exclusive interests of the patient, as the patient's and analyzes patient outcome data with input from the nursing staff advocate, by initiating action to improve healthcare or to change while incorporating clinical decision-making technologies. Hospitals seeking such designation have deployed these clinical decisions or activities which are against the interests or wishes of the patient, as circumstances may require, and by disclosing information technologies, which incorporate Computerized Physician Order and providing patient education as necessary for informed patient Entry (CPOE) systems, computerized charting programs, including computerized medication charting, and decision-support technology decisions about healthcare before care is provided to the patient. 2. The nurse recognizes the importance of collective patient which is based on rigid standardization of the decision-making advocacy to the public health and the integrity of professional nurs- process of the direct-care RN. RNs have a unique patient advocacy role in the healthcare deliving standards of care, and participates in necessary and appropriate actions and exercises of collective patient advocacy to protect the ery system, and technology can only be used to augment this unique public health and safe patient care standards against erosion, role. In analyzing the safe, therapeutic and effective values of any restructuring, degradation, deregulation, and abolition by the large technology, RNs must be able to explore the potential of technology replacing human interaction in healthcare corporations, hospithe delivery of patient care and tal chains, HMOs, insurance "Participation in magnet-acceptable shared the supplanting of critical thinkcompanies, pharmaceutical corgovernance procedures and committees ing and independent clinical porations, and other powerful requires staff nurses to assume expressly judgment with rigid clinical economic institutions and interstated managerial and supervisory pathways or RN displacement ests which today seek to control responsibilities and authority. Such and/or override technologies. the availability, access, and participation provides presumptive evidence Technology-driven care dequality of healthcare services of exclusion from labor law rights personalizes the RN relationship for purposes of profit and surto organize for collective bargaining." with her/his patients. Unfetplus revenue generation against tered use of technology will have a chilling effect on the RN's ability the interest of patients and healthcare consumers. to advocate in the exclusive interest of her/his patient. Undue reliance on technology can jeopardize the accuracy of diagnosis and Independent Professional Responsibility to Act in the Exclusive treatment of patients. Interests of Patients – Direct-Care RN Fiduciary Duty to Patients Such reliance will also create erosion of skills for the next generaState nursing practice acts and registered nursing boards implementing regulations, practice standards, and professional license guide- tion of RNs who (unless stopped) will be trained in tasks instead of lines generally impose a "fiduciary responsibility" on registered educated in skills. It has the potential of destroying the art and scinurses who accept assignment to a direct-care RN-to-patient rela- ence of professional registered nurses. Human cognition is still superior to so-called "machine intellitionship in which nursing care is provided. The fiduciary obligation is to provide care in the exclusive interests of the patient without gence." One fact is certain: computers and machines are only good for compromise or surrender to other interests, including the commer- storing information. They cannot think, analyze, or reason as regiscial, operational, revenue generation, or budgetary interests of health tered nurses do, nor are they educated or capable of critical thinking facility employers, physician practice groups, healthcare systems, or have the ability to make split-second judgments in crisis intervention situations. Computers and machines are capable of quantifying managed care organizations, or health insurers/HMOs. The fiduciary relationship and related professional fiduciary data but it will take a qualified RN to synthesize and interpret the duties of direct-care registered nurses to assigned patients are funda- data – otherwise it is meaningless. In order to be competitive in a market-driven healthcare system, mental public health and safety regulations created to protect patient "Magnet" recognition schemes have endorsed these skill-degrading, safety. RN replacement, obliteration of individual advocacy, and union avoidance clinical technologies. Necessary Conditions for Safe, Competent, and Therapeutic Registered Nursing Practice in the Interests of Patients Protection of working and practice conditions for direct-care RNs THE HEALTHCARE REALITY AND CONTEXT OF MAGNET HOSPITAL RECOGNITION that are essential for safe, competent, and therapeutic nursing care: (1) An RN-to-patient relationship which allows for competent In response to the imperatives of capitation financing and consolidaperformance of all aspects of the nursing process, enforced by objec- tion of the hospital and health insurance industries over the past two tive minimum standards for safe patient care (i.e., numeric unit- decades, aided significantly by federal policies supporting economic concentration in HMO and provider markets, the hospital industry based RN-to-patient staffing ratios); (2) The right and practical ability to exercise independent profes- abandoned safe, therapeutic, and competent nursing care as an opersional responsibility and judgment to determine and implement nurs- ational priority and restructured hospital nursing services to accoming care in the exclusive interests of patients, uncompromised by and modate predominantly revenue generation purposes. Key elements of this restructuring of hospital nursing care are a without interference arising from the conflicting commercial and revsubstantial cause of the current shortage of hospital direct-care regisenue generation interests and demands of the healthcare industry. tered nurses, including the following: (a) mass layoffs and permanent reductions in forces of hospital Magnet Recognition and Replacement Technology To achieve and maintain a "Magnet" designation status, hospitals are direct-care registered nurses beginning in the early 1990s; (b) work "redesign" measures to fragment and deskill hospital required to demonstrate it has a mechanism in place which collects M AY 2 0 0 8 W W W. C A L N U R S E S . O R G REGISTERED NURSE 21