In the Week 7 readings, employee rights and responsibilities are discussed. One item briefly mentioned is the OSHA Whistleblower Protection Program. Do some research and see if you ca

Chapter 11

Employee Rights

and

Responsibilities

Learning Objectives

• Describe and understand the rights of employees.

• Describe the responsibilities of employees in the workplace.

• Discuss what professionals can do to improve professional relationships.

Employment at Will

• The employer or employee may terminate employment at any time: – Unless there is a contract in place that

specifies the terms and duration of employment.

– Public policy considerations. – Implied covenant of good faith and fair

dealing.

An at will prerogative without limits could be suffered only in an anarchy, and there not for long, it certainly cannot be suffered in a society such as ours without weakening the bond of counter balancing rights and obligations that holds such societies together.

—Sides v. Duke

Public Policy Exceptions Prohibiting Termination

• Public policy exception to the employment- at-will doctrine provides that employees may not be terminated for reasons contrary to public policy.

• Public policy originates with legislative enactments.

Freedom from Discrimination

– Disability − Religion – Age − Sex – Race − National origin – Creed − Pregnancy – Color − Filing OSHA complaints

Equal Pay Act of 1964

• Prohibits wage disparities based on sex. • Prohibits discrimination in payment of wages for

women and men performing substantially equal work in same establishment.

• Wages may be unequal as long as they are based on factors other than sex, for example: – Formalized seniority system. – System that objectively measures earnings by

quantity or quality of production.

Refuse to Participate in Care

• Refusal to participate in elective abortion upheld. • Refusal to participate in therapeutic abortion is

insubordinate. • Some pharmacists refuse to fill birth control

prescriptions.

Caregiver’s Right (1 of 2)

The nurse in the operating suite refuses to participate in an elective abortion.

• Discuss how an organization might fairly address this dilemma.

Caregiver’s Right (2 of 2)

• Legal issues – Employee’s right to religious freedom – Organization’s responsibility to provide care

• Ethical issues – Nonmaleficience – Professional codes of ethics

Questioning Patient Care

• Public policy clearly mandates an obligation to serve the best interests of patients.

• Persistence to get the proper treatment for the patient is an absolute duty.

• Case: Paving Her Way to Heaven

Suggesting Change of Physician (1 of 3)

Physician failed to return the nurse’s calls. Because of the patient’s deteriorating condition, the family contacted the nurse. After the nurse advised the patient’s family as to her concerns, a member of the patient’s family asked her what they should do. The nurse advised that she would reconsider their “choice of physicians.” The nurse was terminated because she had advised the patient’s family to consider changing physicians.

Suggesting Change of Physician (2 of 3)

• What action might the hospital might take? • What should the jury do? Discuss your

answer. • Discuss the legal issues in this case. • Discuss the ethical issues in this case. • What was the court’s decision?

Suggesting Change of Physician (3 of 3)

The North Carolina Court of Appeals held that the nurse stated a claim for wrongful discharge in violation of public policy. The nurse’s termination for fulfilling her responsibilities as a practicing nurse violated state public policy and was a factual question for jury determination.

One’s dignity may be assaulted, vandalized, and cruelly mocked, but it cannot be taken away unless it is surrendered.

—Author unknown

Freedom from Disruptive Behavior

• Includes freedom from verbal outbursts and physical threats.

• Prevent disruptive events from occurring. • Deal with events in real time to prevent staff or

patient harm. • Initiate post-event review, actions, and follow-up.

Freedom from Bullying

• Bullying includes: – Abusive conduct – Threats – Humiliating behavior – Name calling – Personal insults

Impact of Bullying

• Lowers morale • Reduces productivity • Increases absenteeism • Increases turnover • Negatively affects patient safety

Freedom from Sexual Harassment

• Employees have a right to be free from sexual harassment.

• Sexual harassment includes: – Requests for a sexual favors. – Sexual advances, condition employment. – Unreasonably interfering with employee's

work. – Creating intimidating or offensive working

environment.

Treatment with Dignity and Respect

• Right to be treated with dignity and respect fairly and consistently.

• Respond to employee complaints and concerns.

Freedom from Intimidation

• Those in power often abuse power through threats, abuse, intimidation, and retaliatory discharge.

• Employees who become targets of a vindictive supervisor often have difficulty in proving a bad-faith motive.

• Some states (e.g., Connecticut, Maine, Michigan, and Montana) have enacted legislation that protects employees from terminations found to be arbitrary and capricious.

Privacy and Confidentiality

• Health status privacy • Fine line to protecting one’s privacy • Reality Checks

– Your Mail Has Been Intercepted – Trust Is Pivotal to Success

Family Medical Leave • Employees have a right to take a medical leave

of absence under the Family and Medical Leave Act (FMLA).

• 12 work weeks of unpaid leave during any 12- month period for: – Birth of a child – Placement of adopted foster child – Care of immediate family member – Serious health condition

Whistleblowing

• Someone “who, believing that the public interest overrides the interest of the organization he serves, publicly blows the whistle if the organization is involved in corrupt, illegal, fraudulent, or harmful activity.”

• Organizations often describe their whistleblower policy in their compliance manuals.

• Demotion, intimidation, reassignment, reduction in work hours, or constructive discharge are prohibited by law.

Employee Responsibilities (1 of 4)

• Know your patient. • Educate and encourage patients to ask

questions. • Be compassionate. • Comply with state and federal regulations. • Comply with hospital policy. • Comply with assigned duties. • Honor and respect patients’ rights.

Employee Responsibilities (2 of 4)

• Maintain confidentiality. – Compliance officer and confidentiality.

• Adhere to safe practices. – Follow hand hygiene guidelines.

• Admit to mistakes. • Adhere to professional standards.

Employee Responsibilities (3 of 4)

• Maintain professional relationships. – Shoot the Consultant – Sexual harassment

• Nurse’s relationship with patient • Physician’s inappropriate house call • Avoid relationships with a patient’s spouse

Employee Responsibilities (4 of 4)

• Report unethical behavior. • Protect patients from harm. • Report patient abuse. • Stand as a patient advocate. • Work with team spirit. • Maintain professional competencies. • Encourage teamwork.

Professional Competencies

• Have current understanding of one’s area of specialization and practice.

• Continuation education. • Current in knowledge and skills.

Helpful Advice (1 of 4)

• Do not say: – The physician is not here when he or she is. – The physician will soon be here when he or

she has already left the building. – This will not hurt, when you know it will. – You are busy when you are not.

Helpful Advice (2 of 4)

• Take responsibility for caring and communicating.

• Include the patient in the decision-making process.

• Take the time to explain to patients the risks, the benefits, and alternatives to each course of treatment.

• Listen to what the patient is saying without interruption.

Helpful Advice (3 of 4)

• Show respect and sensitivity to the patient’s needs.

• Do not make fun of a patient’s decision-making capacity.

• Avoid demeaning and criticizing a patient’s wishes because of his or her frail condition.

Helpful Advice (4 of 4)

• The feelings of the family and those of patient may differ.

• Continue to improve competencies. • Remember that patients can be challenging. • Patient handbooks and employee training. • Patients also have rights and responsibilities.

Caregiver’s Pledge

I will be compassionate.

I will not neglect my duties and responsibilities.

I will read instructions and follow protocols.

I will seek verification of questionable orders.

I will report concerns for patient safety (e.g., staffing concerns).

I will not assume responsibilities beyond my capabilities.

I will call for help when a patient’s medical needs suddenly change.

I will continuously improve my skills and participate in continuing education opportunities.

Review Questions

1. Describe the rights of employees.

2. Describe under what circumstances an employee has a right to refuse to participate in a patient’s procedure.

3. Does a nurse have a right to question the care being rendered to a patient? Explain your answer.

4. Is the employment-at-will concept appropriate in today’s society?

5. Describe the responsibilities of employees as described in this chapter.

6. Describe what caregivers can do to build a spirit of teamwork and improve the quality of patient care.

Review Questions

Chapter 15

Summary Case:

Search for Truth

“There is nothing,” says Plato, “so delightful as the hearing or the speaking of truth”—for this reason there is no conversation so agreeable as that of the man of integrity, who hears without any intention to betray, and speaks without any intention to deceive.

—Thomas Sherlock

Learning Objectives

• Explain how the spoken word may not always clearly describe the intent of the message.

• Describe how values are intertwined in the communication process and how they can be instrumental in changing the course of one’s journey through life.

To laugh often and love much; to win the respect of intelligent persons and the affection of children; to earn the approbation of honest citizens and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to give of one’s self; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to have played and laughed with enthusiasm and sung with exultation; to know even one life has breathed easier because you have lived—this is to have succeeded.

— Ralph Waldo Emerson

Virtues, Values, and Communications

• Each person must evaluate what values and moral strengths are important.

• When responding to the discussion questions following the closet drama in this chapter, apply the virtues and values presented as the pillars of moral strength.

Communications

• Exchange of thoughts, messages, or information through speech, signals, writing, or behavior. – The art and technique of using words

effectively to impart information or ideas. – Includes both verbal and nonverbal

messages. – Requires a sender, a message, and an

intended recipient, the receiver.

Case Characters: Athens Medical Center (AMC)

• Ms. Ophelia Cicero: AMC, survey coordinator and tour guide

Case Characters: Inspection Survey Team

• Mr. Daniel Marcus: Administrative reviewer • Mr. Damon Antonio: Nurse reviewer • Ms. Margaret Galeria: Nurse trainee • Dr. Machiavelli: Physician reviewer

Case Characters: Magistrate and Counselors

• Magistrate: Hearing officer • Counselor Hadrian: Counsel representing

Marcus • Counselor Luke: Counsel representing Dr.

Machiavelli and Damon

Case Characters: Health Review Council

• Mr. Bruce Verus: Marcus’s manager • Ms. Carol Titus: Mr. Verus’s manager

Case Settings (1 of 2)

• Rome – Mr. Marcus’s hometown

• Health Review Council – Entity responsible for evaluating the quality of care in

health centers from Rome to Athens

• Courtroom of Chief Magistrate – Site of the hearing in Athens

Case Settings (2 of 2)

• Athens Health Center – Local medical facility in Athens Marcus was assigned

to review

• Pelopidas Street Inn – Hotel where reviewers lodged

Marcus’s Work

Marcus worked for the Health Review Council, whose mission was to visit health centers from Rome to Athens and review the quality of patient care. He traveled much of the time, writing, consulting, educating, and reviewing the quality of care rendered to the people. His travels took him to hundreds of health centers in villages and cities.

Marcus’s Last Assignment

• This closet drama describes Marcus’s last assignment to review the quality of patient care at the Athens Health Center. – This case illustrates:

• How real-life events can become distorted through political alliances.

• How good and truth, in the final analysis, can triumph over wrong.

Memorable Quotes Often Ignored By Corporate Leaders for Self-Preservation

The most striking contradiction of our civilization is the fundamental reverence for truth, which we profess and the thorough-going disregard for it, which we practice.

—Vilhjalmur Stefansson

The withholding of truth is sometimes a worse deception than a direct misstatement. There is an idiom in truth which falsehood never can imitate.

—Lord Napier

To seek for the truth, for the sake of knowing the truth, is one of the noblest objects a man can live for.

—William Ralph Inge

Discussion

1. Describe the ethical and legal issues in this closet drama as they relate to the various characters.

2. Describe the virtues and values at play.

3. Describe why you think there was a breakdown in communications between Dr. Caesar and Marcus.

Discussion

4. In light of the fact that 70% of diagnoses are made as the result of labs tests, would you expect Marcus to inquire what the lab results had revealed about the patient’s state of health?

5. Describe your overall impression of this case, and how you would have handled it if you were Marcus.

Discussion

6. After considering yourself in the position of each character in this closet drama, describe which role you would have chosen to play. Explain your choice of character.

7. How would you describe the culture of the Health Review Council?

8. Utilizing the communications process in Fig. 15-2, how would you describe the values of each character in this case?