Transcription
HOW ICU NURSESCONCEIVE OFPERSONAL &PROFESSIONAL RISKWHEN EXERCISINGCLINIC AL AUTONOMYB I L L R A N DA L L , P H D, R N , C E NAC A D E M I C S Y M P O S I U MUCD BETTY IRENE MOORESCHOOL OF NURSINGJ U N E 5 TH, 2 0 2 0
NURSING TODAY
DEFINITION:WHAT ISNURSINGCLINICALAUTONOMY?The freedom to do what is inthe patient’s best interestbased on the nurse’sprofessional judgement despiteopposing pressure frominstitutional authorities ordisagreement with membersof other professions.(Kramer & Schmalenberg, 2008; MacDonald, 2002)
a-Varano &Varano, 2014)“BOUNDARY WORK”5
PhysiciansNursesAdministrators
C L I N I C A L AU TO N O M Y R E S E A R C HFor every 1 point1234Autonomy ScaleSample: 20,000 RNs/570 Hospitals/4 U.S. StatesRao, Kumar, & McHugh (2017) 18% lower odds of death &failure-to-rescue
G ROU ND ED T H E ORY ME T H OD OL OGYRecruitmentData Collection27Constant ComparisonData Analysis
HOW ICU NURSES DEFINE CLINIC AL AUTONOMY“Having a Presence” & Feeling Empowered“The re is s uc h an emphas is on co lle g iality and hav ing nurs e s be ‘in thecirc le ’ during IC U mo rning ro unds . Our vo ic e is value d and that make s uss tro ng e r in our pro fe s s io n.”
CONTEXT & CLINICAL AUTONOMY White male nurseExperienced/certified ICU nurseUrban Teaching HospitalDay shiftSupportive physiciansSupportive managersAmple resources African-American female nurse New graduateVS. Community hospital Night shift Physician at home, asleep Uninvolved manager Limited resources
EXERCISING CLINICAL AUTONOMYCollaboratingAvoiding Conflict“Working the System”
ICU Nurses’Conception of RiskLEGAL LIABILITY RISK“We can be a s autonomou s a s we want, but it all mu stb e within that s c op e of practice, so I just ‘stay in m yown lane .’”
EMPLOYER SCRUTINY RISK“Adminis trato rs jus t want yo u to g e t in line and follo wthe rule s . The y do n’t want us to think. But if we follo we dthe rule s , patie nts would die , be c aus e pe o ple do n’tkno w what rule s to make .”
PHYSICIAN-RELATED RISK“The do c got to the patient’s room, took one look at him and startin gy ellin g at me that I had ’probably ju st killed the patient” be cau s e theirblood pre s s ure wa s in the 80’s! I said, “It was like that all night, Sir.The nurs e was s c are d to call yo u!”
RISK OF NOT ACTING“When we’re taking care of your loved ones, you're going towant a nurse like me that’s going to say, ‘Get out of my waybecause I have to save this life!’ instead of someone who just sitsin the corner and does what everyone else tells them to do.”
DISCUSSION
I feel like a trueprofessional.At the end of theday, I feel good.PhysiciansI take controlwhen I must.AdministratorsNursesI’m a patient advocate. Ido what is necessary toc a re we l l fo r my p a t i e n t .
Dissertation Committee Dr. Carolina Apesoa-Varano (chair) Dr. Jodie Gary Dr. Don PalmerClassmates Gennifer Holt Loralyn Taylor Cindi Matsumoto Bola Olarewaju Brenda Chagolla Regina Orozco Karla HodgesColleagues (Samuel Merritt University) Grace Cox Debbie Acker Annmarie Marchi Marianne Biangone Roberta Block Rene Engelhart Richard MacIntyre and many more.Friends & FamilyCookie Wes Randall Sandy Randall Galen Prenevost and many more.My Research Participants
Q &A
WhiteFemaleDEMOGRAPHICS30-39 y.o.ExperiencedBSNAACN MemberDay shiftLarger hospitalSacramento region
Limitations Self-selection bias “Honorable” responses (Pugh) Novice researcherImplications Nursing’s role todayNext Steps Disseminate findings (PUBLISH!) Foster dialogue Support policyDISCUSSION
kRESULTS: MANAGING RISKRisk ofnotacting
COLLABORATINGRESULTS:HOW ICU NURSESEXERCISE CLINIC ALAUTONOMYSpeaking up/Being assertiveSpending social capitalAVOIDING CONFLICT Delaying physician communication Playing the “Doctor-Nurse Game”WORKING THE SYSTEM Circumventing physicians Referring issues to management
R E SULT S: K E Y FAC TOR S T H AT AF F E C T C L I NI C AL AU TONOMYSupportivemanagementProfessionalmembership &certificationRN experiencePositive RN-MDrelationshipsTeaching & orMagnet hospitalBeing male
THANKYOU!!
RESEARCHAIMHOW DO ICU NURSESCONCEIVE OFPERSONAL ANDPROFESSIONAL RISKWHEN EXERCISINGCLINICAL AUTONOMY?
How ICU Nurses Conceive of Personal & Professional Risk When Exercising Clinical Autonomy bill Randall, Phd, rn, CEN Academic Symposium UCD Betty Irene Moore School of nursing June 5th, 2020 Author: William Randall Created Date: 6/23/2020 3:47:50 PM
