RNSG 2138 Professional Nursing Concepts Student Midterm Blueprint Summer 2018
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RNSG 2138 Professional Nursing Concepts Student
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RNSG 2138 Professional Nursing Concepts Student
RNSG 2138 Professional Nursing Concepts Student Midterm Blueprint
Summer 2018
1- Professionalism/Nursing Organization and Unions Pros/Cons to unions
Management of care Planning Analysis Professionalism PowerPoint & Lecture
A. Positive
• Continuity of care
• Continual professional ...
rnsg 2138 professional nursing concepts student midterm blueprint summer 2018 1 professionalismnursing organization and unions proscons to unions management of care planning analysis professionali
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RNSG 2138 Professional Nursing
Concepts Student Midterm Blueprint
Summer 2018
1- Professionalism/Nursing Organization and Unions Pros/Cons to unions
Management of care Planning Analysis Professionalism PowerPoint & Lecture
A. Positive
• Continuity of care
• Continual professional growth
• Active in professional organizations
• Providing a safe patient environment
B. Negative
• Unsafe patient care
• Negative patient outcomes
• Suspension or loss of personal professional license
• Consequences in criminal and/or civil law
• Violations of current practice standards
*When faced with a conflict in the work setting that creates difficulty for a professional nurse to provide safe patient care, the nurse, as a patient advocate,
evaluates taking action to resolve the issue either through work-based organizational structures or pursuit of nursing or non-nursing union involvement.
2- Professionalism/Nursing Organization and Unions Managers role during union organizing Pg 593, marquis
The Managers’ Role During Union Organizing
Because of the health-care industry’s movement toward unionization, most nurses will probably be involved with unions
in some manner during their careers. Managers who are not employed in a unionized health-care organization should
anticipate that one or more unions may attempt to organize their nurses within the next few years.
Because the NLRA provides union protections only to employees, a supervisor has no right under the NLRA to form
,or participate in a union (Department for Professional Employees, AFL-CIO, 2001–2016). Nurse-managers, as legally
defined hospital “supervisors,” are legal spokespersons for the hospital. As such, the NLRB closely monitors what they
may say and do. Prohibited managerial activities include threatening employees, interrogating employees, promising
employee rewards for cessation of union activity, and spying on employees.
This does not mean that these activities do not occur. For example, a complaint was filed with the NLRB in 2014,
alleging that employees who participated in a June 2014 picket (a legally protected concerted activity) to draw attention
to “potentially unsafe staffing conditions” were either fired, experienced revoked work agreements, or forced to work
weekends by the hospital they picketed (“NLRB Hearing,” 2015). Following a 4-day hearing, the NLRB issued a
complaint finding that the hospital had engaged in an illegal pattern of harassment and retaliation against hospital staff
for their participation in the picketing.
3- Professionalism/Nursing Organization and Unions. National Labor Relations Act Pg. 269
The Nurse as Supervisor: Eligibility for Protection
Under the National Labor Relations Act
The NLRA establishes certain protections for private-sector employees who want to form or join a labor union. These
protections do not, however, extend to supervisors. The NLRA defines a supervisor as “any individual having authority,
in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or
discipline other employees, or responsibly to direct them, or to adjust their grievances, or effectively to recommend
such action, if in connection with the foregoing, the exercise of such authority is not of a merely routine or clerical
nature, but requires the use of independent judgment” (Matthews, 2010, para. 12).
However, several 2006 NLRB rulings deemed that charge nurses might also be considered supervisors because they
are responsible for the coordination and provision of patient care throughout a unit (Matthews, 2010). Even part-time
charge nurses were so labeled. The 2006 NLRB decisions—collectively known as the Kentucky River cases, after the
name of the 2005 Supreme Court decision that sent the issue back to the NLRB—expanded the category of “supervisor”
dramatically. The Court found that occasional guidance to other employees was enough to identify someone as a
supervisor (Department for Professional Employees, AFL-CIO, 2001–2016). This finding has been contested legally since
,that time, and several interpretations have occurred. Reinterpretations by the NLRB are expected in the future.
In addition, the definition of supervisor in nursing came into question with several administrative and court rulings in
the early 1990s. These rulings came about as a result of a case involving four LPNs employed at Heartland Nursing
Home in Urbana, Ohio. During late 1988 and early 1989, these LPNs complained to management about what they
thought were disparate enforcement of the absentee policy; short staffing; low wages for nurses’ aides; an unreasonable
switching of prescription business from one pharmacy to another, which increased the nurses’ paperwork; and
management’s failure to communicate with employees (NLRB v. Health Care & Retirement Corp., 1994). Despite
assurances from the Vice President for Operations that they would not be harassed for bringing their concerns to
headquarters’ attention, three of the LPNs were terminated as a result of their actions.
In response to what they perceived to be illegal termination, the LPNs filed for protection under the NLRA. The
NLRB ruled that because the LPNs had responsibility to ensure adequate staffing, to make daily work assignments, to
monitor the aides’ work to ensure proper performance, to counsel and discipline aides, to resolve aides’ problems and
grievances, to evaluate aides’ performances, and to report to management, they should be classified as “supervisors,”
thereby making them ineligible for protection under the NLRA.
On appeal, the administrative law judge (ALJ) disagreed, concluding that the nurses were not supervisors and that
the nurses’ supervisory work did not equate to responsibly directing the aides in the interest of the employer, noting
that the nurses’ focus is on the well-being of the residents rather than on the employer.
In another turnabout, the U.S. Court of Appeals for the Sixth Circuit then reversed the decision of the ALJ, arguing
that the NLRB’s test for determining the supervisory status of nurses was inconsistent with the statute and that the
interest of the patient and the interest of the employer were not mutually exclusive. The court said that, in fact, the
interests of the patient are the employer’s business and argued that the welfare of the patient was no less the object
and concern of the employer than it was of the nurses. The court also argued that the statutory dichotomy the NLRB
first created was no more justified in the health-care field than it would be in any other business in which supervisory
duties are necessary to the production of goods or the provision of services (NLRB v. Health Care & Retirement Corp.,
1994).
The court further stated that it was up to Congress to carve out an exception for the health-care field, including
nurses, should Congress not wish for such nurses to be considered supervisors. The court reminded the NLRB that the
courts, and not the board, bear the final responsibility for interpreting the law. After concluding that the board’s test
was inconsistent with the statute, the court found that the four LPNs involved in this case were indeed supervisors and
ineligible for protection under the NLRA (NLRB v. Health Care & Retirement Corp., 1994).
This same interpretation, at least for full-time charge nurses, was used in another landmark court case in September
, 2006 to determine whether charge nurses, both permanent and rotating, at Oakwood Healthcare Inc. were
“supervisors” within the meaning of the NLRA and thus could be excluded from a unit of nurses represented by
a union (Mayer & Shimabukuro, 2012). Upholding the definition that supervisors “assign” and “responsibly direct”
employees as well as exercise “independent judgment,” the NLRB concluded that 12 permanent charge nurses
employed by Oakwood Healthcare were supervisors. Rotating charge nurses were not if this role was less than 10% to
15% of their work time. The Department for Professional Employees, AFL-CIO (2001–2016) notes that under this ruling,
64 out of 153 nurses at the Salt Lake Regional Medical Center were declared supervisors. For some departments, this
meant 10 out of 12 nurses or ratios of 12 supervisors for every 5 employees.
Matthews (2010) notes that the Oakwood case has set precedence and figured in approximately 35 subsequent
decisions in both health-care and industrial settings, although there have been no further rulings addressing the charge
nurse/supervisor status. Hence, the Oakwood ruling is still in effect today, specifying that nurses, on average, with less
than 10% to 15% (equal to about one shift per pay period) of their time as charge nurse are considered staff nurses,
whereas nurses working more than 15% of their professional time as charge nurses are considered supervisors.
4- Professionalism/Transition to Practice/Benner Level of Nursing Experience .PG 269 marquis
DISPLAY 11.2 Benner’s Levels of Nursing Experience
Novice
• Beginner with no experience
• Taught general rules to help perform tasks
• Rules are context-free, independent of specific cases, and applied universally
• However, rules cannot express which tasks are most relevant in real life or when exceptions are needed
• Has gained prior experience in actual situations to recognize recurring meaningful components
• Principles, based on experiences, begin to be formulated to guide actions.
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