Medications by Unregulated Care Providers (UCP/PSW) Rose McGovern, Director of Nursing for an 80 bed Retirement Home that offers private long-term...
This question has been answered
Question

Medications by Unregulated Care Providers (UCP/PSW)            

Rose McGovern, Director of Nursing for an 80 bed Retirement Home that offers private long-term care supports in an urban setting, has just learned that her home will be moving the medication administration role to the PSW's in her home.

           Mrs. McGovern is outraged. As a longstanding advocate of skilled nursing care in long term care, she knows that administration of medications to elderly clients is much more than the mere giving of ordered dosages of chemical substances. Medication administration provides the best opportunity for the nurse to assess the overall health status of the elderly person. Although UCP's have been allowed to "support" a client to take their medication for years, Mrs. McGovern does not believe that it was meant to be a practice done with patients as medically complex as those in private long-term care.

The provincial and federal nursing associations as well as the Ministry of Health and Long-Term Care have always agreed that the administration of medicines in nursing homes is a nursing function and must be performed by registered staff (RNs and RPNs). Mrs. McGovern maintains that the CNA Code of Ethics for Nurses makes it clear that the health, well-being, and safety of the patient are the nurse's primary considerations. She is convinced that the province has no business allowing there to be a loophole in legislation between the legislation governing long term care homes and those who are registered as retirement homes that offer private purchased long-term care services. She believes that this could easily compromise the health and safety of patients and that due to the lack of oversight by the Ministry of Health and Long-Term Care, that it will not be caught in time to prevent harm to patients.

After a few hurried telephone calls, Mrs. McGovern and her colleagues in the provincial nursing association long term care home team learn that the retirement homes are earning money on both the delivery of the medication, but also in what could be seen as kick-backs from the medication management pharmacy contracted to manage the prescriptions and medication delivery policies, equipment and training. The fiscal management of the retirement home argue that UCP's/PSW's in retirement homes are more cost-effective than registered staff and that only patients approved by the nursing staff will be allowed to purchase medication administration from the UCP's/PSW's. They argue that they will be trained and supervised by the registered staff and will present no additional risk to the residents. Because the number of elderly people needing care that fits the description of long-term care and the cost of employing registered staff have both risen dramatically in the last few years, this decision is seen as a means of providing low-cost care for those able and willing to pay.

Within 36 hours Mrs. McGovern has learned that legally the CNO will not hold the nurse responsible for errors committed by the UCP/PSW so long as there is documentation that the UCP/PSW has undergone appropriate training and that the patient receiving the administration from the UCP is clearly being assisted and is cognitively able to decline medication or advocate for themselves if they are experiencing side effects. Mrs. McGovern has been told my her staff that they worry there will be pressure to "allow" patients on this medication delivery that should not be on it and that their job will be on the line if they stand up to administration and say that residents don't meet the CNO's standards. Rather, their concern is that the nursing profession should have the authority to set the norms for nursing practice, in this case giving the health and safety of resident's priority over the cost saving that seems to get priority in the decision making of companies and that legislation and governance (CNO) should be specific enough to support this in clearly stated language. They also believe that if a retirement home offers services beyond those needed for minimal assistance, even if private pay, should be forced to have to follow the legislation governing the care of patients qualified for long term care.Commentary

This case raises the problem of the relation of the nursing profession to society and what roles the profession and society ought to have in articulating norms of nurse conduct. The current legislation leaves room for creative interpretation. There is likely a component of fiscal over professional when you have business administration and not nursing administration making the final decision on practices that affect patients. The supporters of this type of fiscal decision-making will claim that the UCP's/PSW's would be cheaper and would pose no risk to resident's based on current research. Mrs. McGovern is apparently convinced that patients would face at least some risk if UCP's/PSW's administered medications. She also believes that the language "assisting" and "administering" is interpreted differently by non-nurses and nurses.

The case would become more interesting ethically if both sides were to agree that there is probably some increased risk, even though that risk may be small. If this were admitted, then the dispute might really be over moral principles. Mrs. McGovern appeals to the CNA code to identify the most important ethical principle: protecting the health, well-being, and safety of patients.

If this is not a simple dispute over the matter of whether the use of UCP's/PSW's would lead to increased risks for patients, then it may be a dispute over the relative authority of the nursing profession and the state to determine moral norms for nursing practice. The registered staff is usually responsible for all nursing functions performed by non-nursing staff, including UCP's/PSW's, who work under the supervision of registered staff. If the nurse will still be directly responsible for UCP's/PSW's administering of medications, the effects of those medications, and the potential harm to the patients under his or her care, then there is a dispute over the relative authority of the nursing profession and the government in deciding the acceptable limits of the Registered staff's responsibility.

Some might argue that the nursing profession has legitimate authority for articulating moral norms for nurses but that the government has taken the decision away from nurses by not providing clear guidance and legislation to govern this change in how retirement homes are working around current legislation. That argument might simply shift the issue to whether the profession or society as a whole has the authority to determine what is within the purview of nursing responsibility. In any case, the critical problem remaining is what the relation should be between the profession and the broader society in determining the scope of nurses' responsibilities.

Some would hold that when it comes to articulating moral norms for a professional team such as nurses, the profession is the only team with the experience, skill, and sensitivity to make that articulation. They would ask, "Why should legislators tell nurses what the norms should be for the practice of their profession?"

The defenders of the involvement of the broader society in determining the norms for professionals reject this position. They may well concede that when it comes to matters requiring technical competence, only the members of the profession are adequately experienced to speak authoritatively. Only nurses can make judgments about the appropriate nursing interventions to take in response to actual or potential health problems of the patient. However, they may not be disputing the technical, empirical question of whether patients are at risk (a question about which nurses might claim special expertise). Possibly, they are disputing which of two moral norms is appropriate for institutionalizing policy regarding the administration of medication. If the dispute is really one over moral norms, it is not clear that being a professional in a field gives one expertise in choosing moral norms for social practices. They might, in effect, be disputing how much risk to elderly patients' health is worth taking in order to save money. If that is the nature of the argument, then it could be concluded that the authority of the broader society is substantial. Different teams within society are likely to have different preferences for moral norms. They are likely to have different views about how much risk is worth taking. Nurses may be more inclined against taking risks with patients than the general public is. Some other professional team, such as accountants, however, may be much more supportive of risk taking than the general public is. The issue for consultation is whether the expertise that one gains when one becomes a member of a profession has anything to do with the kinds of judgments required in determining moral norms governing the conduct of the profession as it interacts with the public. Society as a whole may well have authority to articulate moral norms of conduct, such as deciding that marginal risks are justified.

The position of society as the team articulating the norms for nursing is not exactly parallel to the position some other profession, such as that of physicians, would have. It seems clear that one professional team cannot claim the authority to determine what the norms shall be for the conduct of another professional team. It is more difficult to ascertain the extent to which society as a whole should be able to play an active role in determining what the norms of conduct should be for the professions.

  1. Assess the situation. What is the teams' "perceptions" and reflections on the situation - in short form?
  2. Clarify values. What Ethical Values are involved in this story?

Answered by Expert Tutors

e vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac ma

gue

itur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus e

Step-by-step explanation

Donec alique

ng elit. Nam

at, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrice
Get unstuck

479,698 students got unstuck by Course
Hero in the last week

step by step solutions

Our Expert Tutors provide step by step solutions to help you excel in your courses