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Impact on Safe Patient Care and Nurse Retention

Impact on Safe Patient Care and Nurse Retention

Impact on Safe Patient Care and Nurse Retention

Briefly introduce topics of workplace violence and advanced directives. Discuss the ethical dilemmas that can arise on a daily basis when engaging in direct patient care within the healthcare setting.

Workplace Violence

Definitions and Explanation of Workplace Violence

· Discuss the difference between violence occurring between patient and nurse and violence occurring between a nurse and another member of the healthcare team

· Discuss different types of workplace violence: physical, emotional, bullying, intimidation

· “Current literature reports that 20–25% of nursing staff experience bullying behavior” (Wilson, 2016, p. 303).

Impact on Safe Patient Care and Nurse Retention

· Discuss the implications violence can have on nurse’s attitudes and beliefs associated with their job functions

· “those bullied felt isolated, insecure, fearful, and not valued. They also felt powerless, undermined and vulnerable” (Wilson, 2016, p. 304).

· Leads to burnout and nurses leaving due to the maltreatment received

· “Bullying can cause distress and depression, with up to 25% of those bullied leaving their jobs or the profession, and have an impact on patient care” (Wilson, 2016, p. 303).

Evaluation of Rapport between Nurse and Physician

· Within the case study videos, the Physician was annoyed and upset at the fact that the nurse was following proper protocols in regards to obtaining an informed consent. She was rude not only with the nurse but with the patient as well.

· It seemed like the physician was doing the surgery that day only because she would not be there the next day to perform the surgery, not solely because of the severity of the patient’s infection

· The nurse caring for Mary took the appropriate steps in getting her manager involved. Since she did not receive any changes in the physician’s stance on the issues, she involved her manager to advocate for her patient. The manager was then able to initiate conversation with the physician and explain her feelings regarding the legal protocol for informed consents.

Appropriate Leadership and Management Behaviors and Skills

· “People don’t report because they fear retribution, they accept it as part of the job, they don’t think management will do anything about it, or they don’t think that it is severe or serious enough” (2016, p. 44).

· “Good leadership has a profound effect upon organizational effectiveness” (Marquis, 2012, p. 4).

· Leaders are those who follow the proper rules and regulations set by an institution while also building upon good relationships with all staff and patients. They have a joy for the work they do and other staff can see their passion and are willing to follow their lead.

· Just because someone is in a management position does not make them a good leader.

· “Two of the most important responsibilities for a leader is providing vision and being a mentor to followers” (Marquis, 2012, p. 8).

· Reference tables 1.1 and 1.2 in textbook

Advanced Directives

Nurse Responsibility with Advanced Directives

· Provide the patient with all of the information necessary for them to make an informed decision and get help from other interdisciplinary team members like case managers and Chaplains if more information or assistance is needed.

· Facilitate discussions with the patient between family and other pertinent healthcare team members on their wants and wishes.

· “The living will is a document by which a person can register, in accordance with their wishes, which treatments to be submitted to in the case of an incurable disease, to ensure the patients right to die with dignity, in accordance with their personal views” (Cogo, 2015, p. 265).

· The Code of Ethics also supports nurse’s advocacy for patient’s decisions. For example, they recommend that “the choices and values of the competent patient should always be given highest priority, even when these wishes conflict with those of the health care team and family” (Nursing care, 2012, p. 2).

Evaluation of Nurse’s Advocacy for Patient

· The nurse did a great job of involving the physician in the discussion with Tom’s family member regarding the wishes he had verbalized prior to him becoming unresponsive. She took the time to explain to Tom’s son that Tom did not want any “heroic measures” taken to keep him alive. He expressed that he made peace with himself and God and was emotionally and physically ready for when he passes.

Observations Regarding Leadership and Management Skills Used

· The nurse really advocated for what Tom had expressed to her. She was professional, respectful, and compassionate in the way that she approached discussing this difficult time with Tom’s son. She stated Tom’s words and wishes directly so that his son would have a better understanding and acceptance with his father’s wishes. She also included Tom’s longtime physician in the conversation who was there to express not only her professional opinion but her personal one as well-being Tom’s friend.

Evaluation of Leadership and Management Skills Use and Responsibilities and Action Taken

· The nurse was very compassionate and professional in her approach. These are great qualities to aspire to have when being a leader.

· Other skills used were “intelligence, confidence, personal integrity, and interpersonal relationship skills” (Marquis, 2012, p. 11).

· “Confidence and Courage: Believe in yourself and your convictions; have the strength to assert yourself and push forward when you believe in something. Leaders need to have ‘executive presence’” (Mancilla, 2015, p. 38).

· “It is important that leaders or managers understand the ethical and moral dimensions of what they do so they can act professionally, morally and with integrity, while also creating the culture and setting an example as to how other members of the staff will act” (Ellis, 2016, p. 58).

· “Only when managers are able to support staff in ethical and moral decision making can they help reduce the impact of moral distress in their teams” (Ellis, 2016, p. 58).

· When members of the nursing team act ethically and respectfully for their patients and their families, it allows for a more therapeutic relationship to be made and better patient outcomes that adhere to their individualized wishes and wants, especially in regards to advanced directives and end of life care.


Briefly summarize the leadership and management skills witnessed and practiced within the case study videos. Relate it to real life situations that will be encountered by nurses, especially when they are experienced by new graduate nurses.


(2016). Healthcare violence now a public health issue: Moving beyond limited occupational risk review. Hospital Employee Health, 43-44.

Cogo, S. B., & Lunardi, V. L. (2015). Anticipated directives and living will for terminal patients: An integrative review. Rev Bras Enferm, 68(3), 464-474.

Ellis, P. (2016). Leadership skills: the ethically active manager. Wounds UK, 12(1), 58-60.

Mancilla, D., Guyton-Ringbloom, C., & Dougherty, M. (2015). Ten skills that make a great leader. Journal of AHIMA, 38-41.

Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions. (2012). ANA Position Statement, 1-14. Retrieved from

Wilson, J. (2016). An exploration of bullying behaviors in nursing: A review of the literature. British Journal of Nursing, 25(6), 303-306.

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