NR 446 Edapt Week 3 Leading a Team

Student Name

Chamberlain University

NR-446 Collaborative Healthcare

Prof. Name

Date

NR 446 Edapt Week 3 Leading a Team

Transition from Bedside Nurse to Leadership Role

When a registered nurse advances from direct bedside care into a leadership position, their professional responsibilities expand significantly. Beyond delivering patient care, nurse leaders influence healthcare policy, promote safety for both patients and staff, interpret and apply healthcare legislation, advocate for the nursing profession, and ensure compliance with laws regulating nursing practice.

Leaders are responsible for cultivating an environment that meets legal and professional standards, ensuring care is delivered within the scope of practice and aligned with federal laws such as those enforced by the U.S. Equal Employment Opportunity Commission (EEOC). While leaders are expected to safeguard the working environment, each nurse retains personal accountability for their own actions. Encouraging awareness of individual responsibility strengthens professional integrity across the team.

In clinical observations—such as when a nurse prepares medications for multiple patients at once—leaders must consider ethical principles, including nonmaleficence (avoiding harm), fidelity (upholding professional commitments), and confidentiality (addressing mistakes privately). Paternalistic decision-making should be avoided except in urgent situations where immediate intervention is necessary to ensure safety.

Empowerment Through Ethical Actions

Action	Who Benefits	Rationale
Educating clients on self-care	Client	Promotes autonomy, enabling informed health decisions
Supporting expanded nursing scope	Nursing profession	Improves access to care, reflecting beneficence and utility
Volunteering in underserved communities	Client	Advances justice by reducing health disparities
Obtaining informed consent	Client	Respects patient autonomy and protects rights
Supporting whistleblowers	Profession	Demonstrates integrity and protects ethical standards
Advocating for nursing policy reform	Profession	Encourages systemic improvement in healthcare

Ethical Leadership

The American Nurses Association (ANA, 2015) maintains that all nurses must uphold ethical principles. For nurse leaders, the responsibility extends further—they must model ethical behavior, guide their teams with transparency, and ensure fairness in decision-making.

Direct Care Nurse Action	Ethical Principle	Nurse Leader Action
Provides patient education	Autonomy	Ensures fair and consistent disciplinary procedures
Manages pain effectively	Beneficence	Encourages staff development and professional growth
Avoids harmful medications	Nonmaleficence	Implements equitable staff scheduling
Prevents self-harm	Paternalism	Assigns staff based on skills and competence
Assists with duties	Utility	Ensures ill staff are excused from patient care
Delivers equitable care	Justice	Links pay increases to objective performance
Reports medication errors	Veracity	Shares policy changes openly with staff
Honors commitments	Fidelity	Maintains commitments to staff members
Maintains privacy	Confidentiality	Protects both patient and staff information

Ethical Responsibilities of Nurse Leaders

Nurse leaders and managers directly shape workplace culture. They are tasked with upholding ethical standards, reducing risks, protecting human rights, and modeling appropriate behavior for others to follow.

Leadership Roles:

• Maintain self-awareness and a clear understanding of personal values.
• Navigate uncertainty during ethical decision-making.
• Model ethical behavior and set clear expectations.
• Advocate for both patients and team members.
• Represent nursing on interdisciplinary ethics committees.

Management Functions:

• Apply ethical frameworks to guide decisions.
• Weigh legal considerations in ethical dilemmas.
• Identify and address ethical distress in staff.
• Intervene when unethical conduct occurs.
• Recognize and reward ethical behavior.

Creating Healthcare Policies

The National Academy of Medicine report The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity identifies strategic priorities:

• Promoting health equity through nursing initiatives.
• Supporting nurse well-being and resilience.
• Enhancing inclusive data collection and use.
• Expanding nursing education and training.
• Preparing for public health crises.

Nurse leaders are urged to integrate social determinants of health into practice and advocate for equitable, quality healthcare access.

Leader Versus Manager: Legal and Legislative Responsibilities

Leadership Responsibilities	Management Functions
Advocate for patient welfare and informed consent	Maintain current legal knowledge
Model professional nursing care	Ensure policies meet state requirements
Build inclusive, legally compliant workplaces	Educate staff on confidentiality and consent laws
Pursue continuing education	Monitor licenses and ensure equipment safety
Report substandard care promptly	—

Key Legal Topics

Legal Domain	Impact on Nurse Leaders
Licensing/Certification	Verify validity of staff licenses
Collective Bargaining	Promote fair and safe working conditions
Employment Laws	Ensure compliance with EEOC hiring practices

Advocacy in Leadership

Advocacy is central to ethical leadership. It includes speaking up for patients, facilitating ethical discussions, and creating systems where concerns can be addressed without fear of retaliation.

Leadership Traits:

• Foster transparency and advocacy.
• Collaborate with policymakers and professional organizations.
• Support whistleblower protections and safe practice standards.

Management Traits:

• Respect patient values in decisions.
• Provide legal protections for staff.
• Build supportive environments for ethical action.

Ethical Prioritization

Consideration	Priority?	Rationale
ICU experience	Yes	Ensures safe patient care through skills alignment
Nurse preference	No	Patient safety is the top priority

Ethical Scenarios and Principles

When a nurse fails to prevent a patient fall or delivers unsafe care, it breaches nonmaleficence and basic safety obligations. Conversely, a nurse manager supporting a nurse who refuses medication administration due to an allergy demonstrates ethical advocacy.

Principles Overview:

• Autonomy – Respect informed decision-making.
• Beneficence – Promote patient well-being.
• Nonmaleficence – Prevent harm.
• Justice – Ensure fairness.
• Veracity – Uphold truthfulness.
• Fidelity – Keep professional commitments.
• Paternalism – Act in urgent protection scenarios.
• Confidentiality – Safeguard private information.

MORAL Decision-Making Framework

1. Massage the Dilemma – Identify stakeholders and concerns.
2. Outline Options – Develop possible solutions.
3. Review and Resolve – Compare pros and cons.
4. Affirm and Act – Choose and implement a solution.
5. Look Back – Evaluate the results.

Example: If staff raise concerns about ICU transfers, leaders should review transfer data, engage with stakeholders, identify ethical risks, and recommend feasible solutions.

Ethics in Leadership and the Work Environment

An ethical culture reduces moral distress, boosts job satisfaction, and improves patient outcomes. Nurse leaders should:

• Offer ethics education.
• Encourage open discussion of ethical concerns.
• Identify recurring ethical challenges.
• Promote collaborative problem-solving.

Resolving Ethical Conflicts in Nursing

Understanding the Ethical Dilemma
Before resolving an ethical conflict, the nurse must gather complete, relevant data and identify all individuals involved. Once the facts are clear, the nurse can determine key values and explore possible actions.

Contribution to Interdisciplinary Ethics Consultation
In ethics consultations, nurses provide unique insights gained from ongoing patient interaction. Their input may reveal patient values and preferences that guide decision-making, especially in cases involving advance directives.

U.S. Government and Healthcare Legislation

Branch	Responsibility	Examples
Legislative	Creates laws	Senate, House of Representatives
Executive	Enforces laws	President, Vice President, Cabinet
Judicial	Interprets laws	Supreme Court, Federal Courts

Administrative agencies such as HHS and DOJ also enforce healthcare-related laws.

Legal Precedence and Executive Orders: Courts rely on past rulings when laws are unclear. Executive orders cannot replace legislation but may provide supplemental direction.

Constitution and Statutory Law: The U.S. Constitution defines government powers, while statutory law establishes detailed healthcare regulations, including nursing standards.

Legislative Process in the Senate:

1. Bill introduced by a Senator.
2. Bill assigned a Senate number and read.
3. Referred to committee.
4. Committee hearings and revisions.
5. Senate vote.
6. Sent to the House for approval.
7. Forwarded to the President for signature or veto.

Nursing Practice and Legal Considerations

Malpractice Criteria:

• Established nurse-patient relationship.
• Breach of standard of care.
• Harm was foreseeable.
• Actual injury occurred.

Negligence in Nursing:
Negligence occurs when a nurse fails to meet expected care standards—such as administering the wrong medication or ignoring changes in patient status.

NR 446 Edapt Week 3 Leading a Team

Example	Malpractice?	Negligence?
Correct drug with side effect	No	No
Wrong drug dosage	Yes	Yes

Regulatory Oversight:
State Boards of Nursing regulate nursing practice. The Nurse Practice Act (NCSBN, n.d.) outlines state-specific rules.

Error Reporting:
When errors occur, nurses should notify the provider, document accurately, file an incident report, and inform supervisors.

Policy Making in Healthcare

The Executive branch enforces laws, the Legislative branch drafts them, and the Judicial branch interprets them. Agencies like Veterans Affairs (VA) manage benefits, while the Pentagon oversees defense-related healthcare policy.

Employment Law and Safe Work Environments

Legal Protections	Labor Standards	Labor Relations
Work hour limitations	X
Job protection for illness	X
Collective bargaining rights		X
Dispute resolution processes		X

Advocacy in Nursing

Defining Advocacy:
Advocacy is protecting patients’ rights, promoting informed decisions, and delivering equitable care without bias. Vulnerable groups—such as the elderly, disabled, racial minorities, and LGBTQIA+ individuals—may need additional advocacy support.

Advocacy Scenarios:
Examples include ensuring informed consent, supporting refusal of care based on religious beliefs, and providing unbiased care to stigmatized individuals.

Evaluating Policy Effectiveness – Case Study: Leeland Hospital System

Potential Issue	Policy Action Needed
High back injury rate	Update workplace safety policies
Workforce diversity imbalance	Adjust recruitment strategies
High staff turnover	Improve work culture and retention programs

Law and Employment Practices

Employment Type	Characteristics
Full-Time Hourly	Works ≥36 hours/week, receives W-2
Part-Time Hourly	Works <36 hours/week, different benefits
Salaried Employee	Fixed pay regardless of hours worked
Consultant/Subcontractor	Not employed directly, paid via 1099

Legal Hiring Practices:
Employers cannot legally ask about age, disability, or parental status. Hiring must comply with anti-discrimination protections covering race, gender, religion, and other protected categories.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press.

National Council of State Boards of Nursing. (n.d.). Nurse Practice Act. Retrieved from https://www.ncsbn.org/npa.htm

NR 446 Edapt Week 3 Leading a Team

U.S. Department of Labor. (n.d.). Employment law guide. Retrieved from https://www.dol.gov/general/aboutdol/majorlaws

U.S. Government. (n.d.). Branches of the U.S. government. Retrieved from https://www.usa.gov/branches-of-government