Advanced Practice Leadership Paper from an Ethic of Care
Background Information
In the US, there are about 2.9 million nurses, making the nursing field the biggest workforce in healthcare. Nurses practice in several environments such as nursing homes, health facilities among others. This is an advanced practice leadership paper that looks and mobbing and nurse turnover from an ethic of care. Mobbing refers to psychological attacks that contribute to unethical strategies and systematic oppression of individuals so as to reduce performance, coping skills while forcing them to leave their profession (Wang, Cheney & Roper, 2016).
Healthcare is a stressful sector in comparison to a reduced number of nurses, increased nursing duties, inadequate continuing education opportunities, insufficient support from management and mobbing among nursing experts. Historically, respect was at the foundation of nursing, nonetheless, trends of incivility interfere with the environment with cases of horizontal and vertical aggression continues to rise.
Moreover, compounding the rise in mobbing is the difference in age among the nursing personnel. Peterlin, Pearse & Dimovski, (2015) demonstrate that less young graduates are joining nursing practice while more than a half of the practicing nurses are almost retiring in the near future.
This paper also presents a discussion of leadership elements to a nurse practitioner with about ten years of advanced experience in the ambulatory unit and the relationship with nurse executive in a large health facility. The nurse practitioner has applied for full-time work for diabetic foot management. The nurse practitioner has the necessary information for the need or more nurse practitioners to create awareness on diabetic foot exams to patient’s complaints.
The nurse practitioner presents this proposal to the nurse executive who is aware of this incidence as it was already verified and endorsed by the Ambulatory Care Director, however, the nurse executive does not the need to recruit more nurse practitioners. This is because the nurse executive believes that education is part of the nurse practitioner’s role, as such, she has to integrate foot exam in her current work. The nurse executive validates this by alleging that there are inadequate resources.
Additionally, the nurse executive has other priorities while the nurse practitioner is aware that she will be in charge of diabetic foot patients without more staff (Thomas & Rowland, 2014). Patients are already scheduled and the nurse practitioner is not provided time to see new diabetic patients, which makes it intricate for a nurse practitioner to provide an adequate education. Furthermore, a patient develops a severe foot infection that contributes to lengthy hospitalization and leg amputation. The nurse practitioner issued by the patient, and in turn, feels unappreciated and leaves the institution.
Ethic of Care versus Ethic of Justice Perspectives
Ethics refers to right or wrong action in accordance with a person’s responsibility, outcomes, and commitment to the wellbeing of other individuals (Peterlin, Pearse & Dimovski, 2015). The advanced practice leadership between nurse practitioner and nurse executive is a type of mobbing and is illustrated in the perspective of ethics of care and justice. According to Morrow, (2012), ethics of justice is the fairness and mutual agreement of individuals in fair circumstances.
In addition, Morrow presents sections of nursing practice and ethical elements such as bullying, lack of commitment and perceived arrogance. Much as the nurse executive has to distribute resources, the aspect of fairness of ethics of justice can be utilized to justify resource allocation. Conversely, ethics of justice is the fair, verifiable and equal treatment of individuals (Langlois et al. 2014).
In this advanced practice, the nurse practitioner is not given the necessary resources to effectively carry out further duties contributing in harm to patients. Perceived arrogance from nurse executive and inadequate commitment to new programs are major aspects of advanced practice dynamics. To ensure ethics in nursing practice, nurse leaders should promote not only honesty but also integrity and transparency.
Thomas & Rowland, (2014) states that ethics of care involves nurturing and developing harmonious associations from a holistic and need-based perspective while taking into account the requirements of others. The delivery o holistic care has been linked to nursing practice. So as to effectively understand the needs o patients, it is important to care and be sensitive and see patients as whole individuals. Additionally, it is necessary to offer care to nursing experts and considering them as whole people. Delivery of care brings into perspective a variety of activities beyond individuals as well as biological scope (Langlois et al. 2014).
For instance, Thomas & Rowland, (2014) presents cases of horizontal and lateral hostility including humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties and diminishing self-worth. Nurse practitioner not given the required support may experience mobbing and lateral aggression.
Therefore, mobbing must not be tolerated in advanced practice leadership or even perpetuated among nursing leaders. As nurses are cared for they develop qualities o their mentors while embodying them in their practice. This cycle o mobbing in nursing should be prevented and it is in the nursing leadership that it should first occur. Leaders should train new leaders with care, empathy and holistic management of staff and patient can result in stable nursing force while stopping nurse turnover. This is likely to lead to a culture based on ethics of care.
The application from an ethic of care dynamic Scholars has widely discussed humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties and diminishing self-worth. Other mobbing strategies include withholding promotion, isolating nurses from team activities.
The ethics of care is used to describe these factors in the present healthcare environment. Demeaning behaviors involves criticizing a nurse in front of others. Verbal disrespect of a nurse is a common type of mobbing. For instance, while this is evident in the interaction between experienced nurses and new RNs entering nursing practice, the new RNs need not only support but also guidance.
Instead, they are subjected to criticism nurses that disagree with these actions and do nothing to prevent it are also committing demeaning actions. A person committed to fostering ethics o care aims at fulfilling other individuals’ needs to ensure harmonious associations (Wang, Cheney & Roper, 2016). The executive nurse belittled the needs of nurse practitioner that contributed in harm to the patient as well as lost o experienced nurse practitioner. Aggressive and disparaging acts lead to physical harm and psychological bullying.
Gossiping is the prevalent type of mobbing leading to psychological distress among nurses. Much are nurses are ready to embrace change, negative words drain their energy (Turkel, 2014). Nurse to patient ratio is another element used to mob nursing experts by distributing a disproportionate number of patients or each nurse. For instance, the executive nurse undermined the need or diabetic foot assessment and awareness, which created workplace setting or nurse practitioners that in turn undermined the executive nurse’s confidence and self-esteem.
Conclusion
In nursing practice mobbing is common. As a psychological attack, it is not only unethical but also one that affects nurse performance and retention. Nurse leaders and staff should comprehend the perspective of ethics of care and ethics of justice to acknowledge and combat mobbing among nursing staff. Additionally, nurse leaders must not condone mobbing instead they should adopt robust and ethical nursing principles.
Some of the tactics of mobbing discussed include demeaning behaviors, humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties, withholding promotion, and isolating nurses from team activities. Nurse leaders’ should utilize ethics of care as the basis or deal with issues associated with patients and nursing staff. Nurse leaders should also regular training for all nursing staff to be able to identify mobbing and ensure a supportive, equal and holistic workplace setting.
References
Langlois, L., Lapointe, C., Valois, P., & de Leeuw, A. (2014). Development and validity of the ethical leadership questionnaire. Journal of Educational Administration, 52(3), 310-331. doi: http://dx.doi.org/10.1108/JEA-10-2012-0110
Morrow, M. R. (2012). Fairness and justice in leading-following: Opportunities to foster integrity in the first 100 days. Nursing Science Quarterly, 252, 188-193.
Peterlin, J., Pearse, N. J., & Dimovski, V. (2015). STRATEGIC DECISION MAKING FOR ORGANIZATIONAL SUSTAINABILITY: THE IMPLICATIONS OF SERVANT LEADERSHIP AND SUSTAINABLE LEADERSHIP APPROACHES. Economic and Business Review for Central and South – Eastern Europe, 17(3), 273-290. doi:http://dx.doi.org/10.15458/85451.4
Thomas, M., & Rowland, C. (2014). Leadership, pragmatism, and grace: A review. Journal of Business Ethics, 123(1), 99-111. doi:http://dx.doi.org/10.1007/s10551-013-1802-3
Turkel, M. C. (2014). Leading from the heart: caring, love, peace and values guiding leadership. Nursing Science Quarterly, 272
Wang, Y., Cheney, G., & Roper, J. (2016). Virtue ethics and the practice-institution schema: An ethical case of excellent business practices. Journal of Business Ethics, 138(1), 67-77. doi: http://dx.doi.org/10.1007/s10551-015-2579-3
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