Using a mock board of pharmacy disciplinary hearing to teach concepts related to administrative law, addiction, empathy, and professionalism.

BACKGROUND AND PURPOSE: The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction. EDUCATIONAL ACTIVITY AND SETTING: The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions. FINDINGS: Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion. SUMMARY: Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.

Unmasking the open secret of posting and transfer practices in the health sector.

This article focuses on processes of granting posts and transfers to health care workers and administrators that can be described as 'mission inconsistent (MI)', meaning that they are not conducted in a way that maximizes health outcomes or that respects the norms of health care worker professionalism. We synthesize relevant literature from several different disciplinary perspectives to describe what is known about the problem of MI posting and transfer in the health sector, to critically engage and interrogate these literatures, and to briefly discuss efforts that have been made to maximize mission consistency. The article concludes by suggesting principles for future research that would foster a more complete understanding of posting and transfer practices.

Just culture-changing the environment of healthcare delivery.

Although errors cannot be totally eliminated, they can be reduced by adopting a system of accountability that requires employees to self-report errors in the interest of patient safety. Traditional laboratory accountability systems are based on a culture of blame, focusing on punishing individuals, and with little emphasis on learning lessons from the errors. Under a just culture laboratory accountability system, if factors in the environment or process contributed to an error, the individual should not be punished. Rather, they and the system can both identify improvements for processes so that this type of error does not reoccur. Using this approach, laboratory services can be made safer for current and future patients.

Does the risk of reprisal prevent nurses blowing the whistle on bad practice?

BACKGROUND: Despite the introduction of legislation to protect people who report poor or unsafe practice, whistleblowing can still have serious consequences for nurses. AIM: To review the literature on whistleblowing in healthcare, and explore the barriers to reporting poor practice. METHOD: Studies focusing on whistleblowing in healthcare were used to assess the safety of incident reporting, and to determine what prevented nurses from reporting poor practice. RESULTS: Four major themes were identified as the main barriers to whistleblowing in healthcare: experience of the nurse; confidentiality and reporting processes; incident severity; and personal beliefs. CONCLUSION: Reprisal for whistleblowing remains a major concern for nurses. Patient safety could be improved by prioritising confidentiality and creating an environment where nurses feel safe to report poor practice.

Managerial leadership is associated with employee stress, health, and sickness absence independently of the demand-control-support model.

OBJECTIVES: Research on health effects of managerial leadership has only taken established work environment factors into account to a limited extent. We therefore investigated the associations between a measure of Attentive Managerial Leadership (AML), and perceived stress, age-relative self-rated health, and sickness absence due to overstrain/fatigue, adjusting for the dimensions of the Demand-Control-Support model. PARTICIPANTS: Blue- and white-collar workers from Finland, Germany and Sweden employed in a multi-national forest industry company (N=12,622). METHODS: Cross-sectional data on leadership and health from a company-wide survey analysed with logistic regression in different subgroups. RESULTS: AML was associated with perceived stress, age-relative self-rated health, and sickness absence due to overstrain/fatigue after controlling for the Demand-Control-Support model. Lack of AML was significantly associated with a high stress level in all subgroups (OR=1.68-2.67). Associations with age-relative self-rated health and sickness absence due to overstrain/fatigue were weaker, but still significant, and in the expected direction for several of the subgroups studied, suggesting an association between lack of AML and negative health consequences. CONCLUSION: The study indicates that managerial leadership is associated with employee stress, health, and sickness absence independently of the Demand-Control-Support model and should be considered in future studies of health consequences for employees, and in work environment interventions.

From blaming to proactively changing the future: the leader's safety challenge.

Simplifying to the point of blaming limits learning and the ability to prevent similar occurrences in the future. Often, the characteristics of the blame culture are very subtle and what appears to be valuable work is actually a subtle sign of the blame game. Leaders must change the language to a proactive, future preventative state rather than focusing on the past and looking for single causes of events. Many nurses have left their positions because they have chosen not to work in a culture of blame. Eliminating all forms of blame is essential for excellence in patient care outcomes and loyalty of staff.

Addressing the underperformance of faculty and staff.

Many new nursing leaders assuming work as deans, assistant deans, or interim deans have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, both deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Processes for disciplining nurses for unprofessional conduct of a serious nature: a critique.

AIMS: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies. BACKGROUND: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses. METHODS: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies. RESULTS: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors. CONCLUSION: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

A positive look at progressive discipline.

Health care organizations must employ individuals whose performance meets job standards in order to be successful in today's dynamic health care environment. Use of an effective progressive discipline program is one technique to accomplish this objective. This article explores reasons for using progressive discipline, explanations for why supervisors avoid taking disciplinary action, benefits of progressive discipline, the four stages of a progressive discipline procedure, and exceptions to applying progressive discipline.

Effect of an administrative intervention on rates of screening for domestic violence in an urban emergency department.

OBJECTIVES: This study measured the effects of an administrative intervention on health care provider compliance with universal domestic violence screening protocols. METHODS: We used a simple, interrupted-time-series design in a stratified random sample of female emergency department patients 18 years or older (n = 1638 preintervention, n = 1617 postintervention). The intervention was a 4-tiered hospital-approved disciplinary action, and the primary outcome was screening compliance. RESULTS: Preintervention and postintervention screening rates were 29.5% and 72.8%, respectively. Before the intervention, screening was worse on the night shift (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.31, 0.68) and with psychiatric patients (OR = 0.34, 95% CI = 0.14, 0.85); after the intervention, no previous screening barriers remained significant. CONCLUSIONS: An administrative intervention significantly enhanced compliance with universal domestic violence screening.

Responses and concerns of healthcare providers to medication errors.

This descriptive, correlational study examined the responses and concerns of healthcare professionals about making medication errors and estimated patient harm from such errors. A systematic random sample of nurses, pharmacists, and physicians (N = 402) completed a self-report survey about a medication error they judged to be serious. Respondents were guilty, nervous, and worried about the error. They feared for the safety of the patient, disciplinary action, and punishment. A few subjects indicated that they never reported the errors. The most frequent symptoms associated with errors were neurologically based. The injury suffered by patients was not severe overall according to the harm scales. Weak correlations were found for the harm scales and responses and concerns. The authors suggest a supportive environment for the provider following an error and continuous quality improvement efforts to eliminate system-based errors.

Sexual harassment: guidelines for laboratory managers.

Sexual harassment can poison a work environment, create legal problems, and cause productivity to suffer. Excellent clinical laboratories recognize its potentially disruptive effects and develop proactive strategies to deal with sexual harassment while enacting policies that prevent its occurrence. This article outlines steps to be taken when sexual harassment is alleged. A sample organizational policy on sexual harassment is also included.