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PubMed1998

Protecting the whistleblower: preventing retaliation following a report of patient abuse in health-care institutions.

Health-care providers throughout the United States face litigation and the threat of litigation on a daily basis due to claims of patient abuse. Hidden within the costs associated with defending patient abuse claims are the wrongful termination filings made by employees who claim they were retaliated against for their whistleblowing activity. The purpose of this paper is to demonstrate why an employer would resort to retaliatory acts in the shadow of a patient abuse filing and to discuss what steps are currently taken to prove and investigate the validity of a retaliation claim. Included within the body of this paper are court decisions on the topics of whistleblowing protection and violation of public policy. These examples are illustrated so that recommendations can be provided that assist the employer in avoiding a wrongful discharge claim and help to conclude that retaliation against the whistleblower is a costly mistake even with the employment at-will principle as a defense.

Duty to Warn↗
PubMed1990

Alcoholism and drug abuse--some legal issues for employers.

Three specific areas of the law concern employers faced with problems of addiction at the workplace. At common law an employer may be guilty of negligence where a person has suffered personal injuries or economic loss as a result of an act of negligence committed in the course of employment by an employee. An example would be an employee with a serious addiction to alcohol or drugs who caused an accident in the company car whilst on company business. Employers may also be guilty of a criminal offence for breach of a statutory duty. One such duty is to have a 'safe system of work'. Other statutory rights guarantee employees a right not to be unfairly dismissed and this includes employees with addiction problems. Lastly, employers must be careful not to break the contract of employment if, for example, an employee with an addiction problem were to be suspended from duty or have his company car withdrawn, even if this was a temporary measure only.

Accidents, Traffic↗
PubMed1994

Alcohol and depression in English and American lawyer disciplinary proceedings.

This paper gives a comparison of the approach of the US courts and of the Solicitor's Disciplinary Tribunal in England to disciplinary proceedings concerning lawyers suffering from alcohol dependence and/or depression. A richer case law in the USA indicates a more sophisticated approach, higher standards as to evidence and better support systems for lawyers in recovery. Useful lessons could be learned from the American experience and the experience of doctors and dentists by English lawyers.

Alcoholism↗
PubMed1994

Nurses' medication errors.

This paper reports on a qualitative study of nurses' experiences with medication errors. Using discourse analysis within a framework of an interpretive research design, the phenomenon of a not too uncommon occurrence in nursing practice was examined. Insight into nurses' involvement with medication errors was gained from interviews, group discussions and self-reports. Documents of disciplinary proceedings, where the Professional Conduct Committee of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting has dealt with incidents of medication errors, supplemented the data. Decisions made in situations of medication errors have moral implications at personal, institutional, and professional levels. The moral courage that is needed to learn from mistakes can be enhanced through honest dealings with the situation. Where the attention is shifted from the person involved onto the problem at hand, fair judgement may be advanced and the fear of owning up to a mistake be diminished. Only when reflected upon, can personal experience merge into the stream of development and progress. This study contributes to such reflection. Three key issues are discussed in-depth as they evolved during analysis of the data: These issues deal with identification and change; with guilt and shame and the reconciliation with human precariousness; and with teaching and learning. The manner in which discourse analysis was used here represents an innovative attempt to advance qualitative methodology in nursing research.

Adaptation, Psychological↗
PubMed2005

Nurses' views on ethical codes: a focus group study.

AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.

Adult↗
PubMed2005

In the public interest: autonomy and resistance to methods of standardising nurses' advice and practices from a health call centre in Perth, Western Australia.

The history of nursing is replete with examples of nurses battling for autonomy over their education, knowledge and work practices. The latest battleground is HealthDirect, Australia's first medial call centre, where nurses are required to meet externally imposed clinical standards while satisfying legal and financial obligations. These objectives are arguably achieved when nurses assess callers' health problems via computerised algorithms that determine an appropriate plan of action. That way, nurses' subjective responses to callers are ruled out. To ensure nurses comply with the standard processes, calls are monitored randomly and surreptitiously in formal and informal ways. This paper explores how nurses respond to standard procedures and surveillance, in order to argue that nurses' input partially drives reform processes. Nurses continue to seek autonomy over the advice they give and how their work is evaluated but are constrained by structural power relations.

Algorithms↗
PubMed2006

Workplace bullying in nursing: towards a more critical organisational perspective.

Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence'. It is proposed that the use of 'oppressed group' behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of 'oppressed group' behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, rather than considering it within the broader organisational context. The work of Foucault and the 'circuits of power' model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce.

Attitude of Health Personnel↗
PubMed2006

"Health courts" and accountability for patient safety.

Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations.

Compensation and Redress↗
PubMedDate not supplied

The risk of action by the Drug Enforcement Administration against physicians prescribing opioids for pain.

OBJECTIVE: Fear of government actions against physicians for prescribing opioids for their chronic pain patients is a cause for undertreatment of pain. This study was conducted to assess the risk of action by the federal Drug Enforcement Administration (DEA). METHODS: The DEA responded to a written request with a list of all DEA arrests in fiscal 2003. The Federal Register was reviewed for all revocations of DEA registrations for 2003 and 2004. RESULTS: There were 47 arrests in 2003 from among 963,385 doctors registered with the DEA and 56 revocations of registration seen in the 2003 and 2004 period. The reasons for these actions included loss of medical license, fraud, substance abuse by prescriber, sex in exchange for prescriptions, and prescribing without seeing patient. For the majority of cases, there was information to believe that a documented doctor-patient relationship with a chronic pain patient did not exist. CONCLUSION: When adequate documentation exists in the medical record, the risk of civil, criminal, or administrative action being taken by the DEA against a physician for prescribing opioids for a chronic pain patient is small.

Crime↗
PubMed1992

Minimization of workplace alcohol problems: the supervisor's role.

Based on findings from an ethnographic analysis of an assembly plant in a large manufacturing industry, this paper delineates a conceptual framework for "minimization" that proposes to explain the interactional processes leading to systemized weakening of alcohol problem awareness and action in the unionized workplace. In the course of 50 semi-structured interviews and observations with union representatives and management, the role of the first-line supervisor emerged as pivotal to minimization. Individual case studies from the ethnography and responses from a survey sample of 1000 employees are used to illustrate how goals and processes of the workplace culture impede forthright action and clear lines of decision making on alcohol issues.

Adult↗