Interview Nurse Interviewing a Registered

Interview Nurse

Interviewing a registered nurse and how her profession relates to topics covered in business law.

There are many legal and ethical issues facing registered nurses in today's society. I interviewed a registered nurse that works in the OB/GYN department of a major medical provider. She has worked in this position for the last five years, thus is well versed in issues surrounding law and medicine. The primary concerns with regards to legal and ethical issues surrounding her career choice relate to ethical considerations and legal systems being utilized in today's medical communities. Administrative regulation also came up as a topic of concern during the course of the interview. The results of the interview as well as supporting evidence from current research is presented below.

Interview Synopsis

One of the first topics discussed were the challenges facing nurses in today's economy. Based on an analysis of the economy in general and the current status of nursing within the United States, among the primary considerations legally and administratively for a majority of nurses, as confirmed by the interview include: inadequate staffing, mandatory overtime and associated scheduling practices, ethical questions, occupational hazards and burn out (Guevara & Mendias, 2002). All of these issues have potential legal pitfalls.

The most pressing of these issues related to mandatory overtime, scheduling practices and the potential for occupational burn out and compromised care. More and more nurses that were trained for one job function are being assigned numerous job functions inside of and outside of the scope of their position. Though they are compensated for overtime they are putting in, they are not necessarily uniformly being compensated for increased job responsibilities. Though nursing organizations are standing up for the rights of nurses, many are leaving the industry due to the increased demands and lack of adequate compensation for these demands. Generally nurses are being assigned to care for more patients and assigned more paperwork responsibilities and management responsibilities.

Technology has allowed nurses to be assigned more tasks and now requires that they learn the skills necessary to perform these tasks in a shorter period of time. There are increased managed care system demands placed on nurses and health care continues to be privatized within the United States, further increasing the burdens and demands placed on nursing care professionals.

The law dictates that nurses have a responsibility to perform certain job functions within the scope of their practice, but the scope of their practice is continually changing given the increased demands placed on nurses across different specialties within the United States and even within other countries. The legal issues facing nurses in the United States including questions of ethics and system management are not unique to the United States alone (Guevara & Mendias, 2002).

Due to a shortage of nurses available in the United States, my interviewee suggested that the nurses currently working in the field are overworked, underpaid and over stressed. This in and of itself is an issue that is important because it may contribute to compromised medical care. Compromised medical care is a concern nurses, physicians and more importantly, the patients receiving the care.

In fact, perhaps the biggest issue facing nurses is the potential for compromised care, and resulting lawsuits that might ensue if patients aren't cared for properly. Malpractice insurance is actually on the rise among OB/GYN's according to the nurse interviewed, and many are dropping out of practice because they are no longer able to afford insurance. The lack of available and qualified OB/GYN's have left more responsibilities delegated to nurses who may or may not be adequately trained or professionally qualified to deal with them.

How is this affecting the nursing practice specifically? According to my interviewee, there is a shortage of nurses available to manage the demands the medical community is placing on them. This results in burn out, over-extended hours on the job, and encouragement of nurses to carry out functions they may or may not be adequately trained for. From an ethical standpoint, patients are being deprived of the high quality, direct care service they deserve and have come to expect from the medical community.

Instead of direct care from a nurse they are more likely to receive assistance from a nurse associate or other member of the medical staff, who may or may not be as knowledgeable regarding a patient's needs. The patient also does not necessarily have a choice in this matter, further complicating issues and leading to the potential for malpractice claims and other legal problems. Increasingly patients are asked to 'sign away rights' or documents limiting liability of medical care providers, which opens the door for ethical evaluation of the medical care practice.

In addition, many nurses are in a compromised emotional state, coming to work with negative attitudes and beliefs that have the potential to limit their ability to provide effective and responsible care for patients under their surveillance. This is also an ethical and moral concern that has yet to be adequately addressed within the field.

From an ethical perspective, nurses have an obligation to provide personal care to protect patients to the utmost of their ability. They also have an obligation to protect patient's best interests while maintaining a patient's confidentiality. Given the current organization structure of many health care systems, performing this basic function is almost impossible however.

With regard to administrative regulation, nurses have an increased burden resulting from new HIPPA legislation that requires additional paperwork to ensure patient confidentiality issues are handled with the utmost care. The interviewee reported having to complete large amounts of paperwork in addition to caring for an increased load of patients. The documentation required to compete paperwork adequately is almost enough to justify hiring more nurses simply to take care of paperwork demands.

Another trend in the industry as suggested by the interviewee has been less direct patient care, simply because nurses lack the time necessary to work with patients one on one. In many cases there are more patients but less staff available to accommodate their needs. Thus patients are being treated by assistants that aren't qualified to care for patients in the same way that nurses are.

Technological advances within the medical system have also resulted in increased demands on nurses (Guevara & Mendias, 2002). Nurses are now using computers to check order and charts, update patient status and communicate information to physicians among other things (Guevara & Mendias, 2002). The interviewee suggested that computers are actually helpful in some aspects, but the increasing technological advances continually are forcing nurses to update their skills, and they have little time to keep up with things as they exist at present.

There are requests that nurses keep up-to-date with continuing educational requirements including those that will advance nurses technological skills. Clients are also requesting more information of nurses, demanding that they understand more about the disease process in addition to understanding technology (Guevara & Mendias, 2002).

Within the U.S. In general, the interviewee reported that nurses are charged with more time spent managing other staff and handling paperwork and less time directly addressing the needs of patients, a fact supported by research (Guevara & Mendias, 2002). Many are also working within the limits of managed care which typically dictates reimbursable services (Guevara & Mendias, 2002). Because of the impact of managed care nurses are required to spend more time documenting patient services to ensure reimbursement (Guevara & Mendias, 2002). This was confirmed through the interview.

One of the biggest obstacles as expressed by the interview was the burden managed care corporations were placing on health care providers in the United States to document every detail of service down to the exact minute, an almost impossible task given the staffing and time limitations already imposed on nursing care providers.

Conclusions

Legal and ethical concerns are among the primary concerns of most nurses working in the industry according to the interview. There is an increased incidence of worry and concern over malpractice claims which increasingly award patients higher amounts of money for patient's winning cases. Unfortunately this has led to many nurses practicing defensive care rather than preventive and supportive care (Guevara & Mendias, 2002: 350). In some cases this may lead to overly conservative treatment of a patient's condition.