RIGHTS AND RESPONSIBILITIES FOR NURSES: ANOTHER LOOK By Roberta B. Abrams, RNC, MA, LCCE Several years ago, as a member of a Patient Relations committee, I participated in writing a "Patient's Rights and Responsibilities." The purpose of the document was to set forth clearly, both for caregivers and for care recipients, a set of guidelines for our mutual efforts in restoring patients to optimal health. The document expressed concepts such as the patient's rights to individualized treatment, respect and privacy. It detailed the patient's rights to a clear understanding of the expected outcomes of care - including benefits and anticipated risks. The Patients' Bill of Rights and Responsibilities expressed the patient's responsibilities for following the expected care regimen. It delineated the patient's right to disagree with caregivers, to request a consultation with another caregiver, and to express both satisfaction and dissatisfaction with care provided. There is a widespread interest in nursing as a profession. Nurses, other care providers, healthcare administrators and consumers are all concerned about the current nursing issues. Among other questions, they want to know what nurses want and need to bolster their professional practice. They want to know how to encourage more people to enter and remain in active nursing practice. They want better understanding about the scope and nature of nursing practice. One way to answer these questions is to construct a 21st century Nurse's Bill of Rights and Responsibilities: Nurses' Rights I. Nurses have the right to be recognized as health professionals with a defined scope of practice that is unique to the profession. We need to articulate our scope of practice in a manner that is accepted and understood by all. Many of our health consumers still lack a real knowledge of the responsibilities of the contemporary nurse. For too long we have sought refuge in nursing "jargon" that is explained to each other, but neither valued nor understood by those outside the profession. That understanding must occur before nursing can realize its future. II. Nurses have the right to be recognized as practitioners of quality, cost-effective healthcare. They need to be compensated in a manner equal with their responsibilities and with the quality of care they provide. Those responsibilities and that compensation must be supported by public policy. Nursing is still listed as a "cost center" in most healthcare organizational budgets. The "costs" for nursing care form a large part of that provider's budget, and thus make a seemingly attractive target for short-sighted "budget fixers." However, patients are admitted to hospitals and other provider venues because they require care which is provided by nurses. Given that,nurses and nursing care should be regarded as a revenue center, and its costs valued as such. III. Nurses have a right to a seat at the table where healthcare policy is formulated so that they can speak to the issues involved in establishing and maintaining healthcare delivery systems. For too long, nurses have been the recipients of policy developed and implemented by people who may have no working knowledge of patients' needs or nursing issues. Nurses need to be both visible and articulate in any arena where healthcare policy is formulated, whether that is in a boardroom or a legislative arena. We need to develop a cadre of expert practitioners to collaborate with all other stakeholders in development of policies at the local, state, and national levels. We need nursing leaders who are able and willing to speak for nursing at the table where decisions are made and organizational budgets are formulated. IV. Nurses have the right to lead and direct their own practice. The magnet health facilities have shown us the value of shared governance in nursing. In places that maintain nurses' autonomy, care outcomes are improved, and staff retention is manifested in a body of nurses whose tenure and skills provide excellence in patient care. Collaborative practice committees have demonstrated the value of nurses working with other practitioners to research and develop practice patterns based on sound outcome-driven data. V. Nurses have the right to personnel and material resources commensurate with the area and scope of their responsibilities. A major source of dissatisfaction for today's professional nurse is the lack of adequate and appropriate staff, and the lack of equipment needed to provide quality care. Mandatory overtime, regular use of agency personnel, continuous need to orient new or inexperienced staff, dependence on outmoded equipment, and lack of requisite care supplies all add to the frustration of nurses who are responsible for quality care of patients with increasing acuities. Wise leaders recognize that appropriate staff and supplies obviate patient errors and improve outcomes. Quality is cost-effective. Nurses' Responsibilities I. Nurses have the responsibility to advance their professional abilities through ongoing professional education. Nursing practice is constantly changing. New modes of treatment, research into treatment efficacy and the constant advancement of our knowledge about patients and their problems mandate that the nurse in practice today be involved in continued professional development. Wise leaders encourage staff development by supporting attendance at continuing education conferences and membership in professional nursing organizations. Wise nurses use these opportunities, as well as journal readings, in-house and computerized educational media to support their own growth and development. II. Nurses have the responsibility to collaborate with one another and with other health care provider colleagues to develop and implement integrated models for healthcare delivery through research, education, and practice. These collaborations must also work at developing public policy to improve the health of the populace for whom they care. As nurses, we must formulate strategic partnerships to promote the use of research data and evidence based practice in developing and implementing new and improved patterns of care. Too much of our current practice is predicated on "traditions" which no longer have validity or which result in expensive, sub-optimal outcomes. It is our responsibility to work within our own profession, and with other professionals to examine all current practices, promoting those whose efficacy provides the best possible outcomes to each patient and for each episode of care. III. Nurses have the responsibility to advocate for advances in healthcare policy and legislation. As the largest single body of healthcare providers, nurses must collaborate with each other and with members of other provider professions to develop and promote evidence-based health policy. We must educate and communicate with healthcare providers, with consumers, and with legislators to promote policies that increase access to healthcare services and competent, cost-effective healthcare. IV. Nurses have the responsibility to promote nursing's image, and knowledge of nursing's role in the healthcare delivery system to each other, to other professionals and to the general public. Nursing guru, Leah Curtin, has told us that: "Nursing is the only profession that eats its young." Too many nursing gatherings become venues where nurses gather to complain about each other, about "higher ups," and about the conditions under which they work. While understandable, these conversations tend to be counterproductive. They don't fix the situation; they merely create a "miasma of misery" which makes nurses wonder why they remain in nursing. We need to reframe our viewpoints. We need to become advocates for requisite improvements in the practice settings. We have the responsibility to articulate our needs to those who have the ability and authority to provide those improvements. We are responsible for supporting and nurturing our younger colleagues so that they may develop the skills and abilities to take their rightful place in the healthcare arena. We have the responsibility to ameliorate conditions within nursing so that it becomes an attractive consideration for today's young men and women. V. Nurses have the responsibility to be advocates for and promoters of health for all persons. Nurses are responsible to work in collaboration with other healthcare providers, with community groups, and with the legislatures to increase the years of healthy life of the people in the community and to eliminate disparities in healthcare delivery systems. Most of us are aware of the precepts set forth in Healthy People 2010. We recognize that the majority of healthcare expenditures are spent on restoration of health, and only a small percent on health promotion. We are similarly aware of the large numbers of people who are without appropriate access to the healthcare system because of economic issues. Nurses are advocates for those in their care. It is an appropriate extension of our responsibilities to extend our advocacy to those in the community in which we serve. We need to work with others to reframe health care delivery systems and to end inequities in care. The end result should be improvements in the public health and improvements in the economics and outcomes of care. The representatives from major nursing associations who prepared Nursing's Agenda for the Future (2001) under the auspices of the American Nurses Association said it best: "Nursing is the pivotal healthcare profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care. The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems. Individuals choose nursing as a career, and remain in the profession, because of the opportunities for personal and professional growth, supportive work environments and compensation commensurate with roles and responsibilities." The Rights and Responsibilities for Nurses is a document that requests study and continued revision. As nursing and healthcare change, so will our rights and responsibilities. Nursing asks much of its practitioners. As a profession we strive to improve our abilities to meet the needs of those we serve. We appreciate the intangible rewards, and seek the tangible: A place at the table of decision, and reward commensurate with the skill, knowledge and effort involved. -------------------------------------------------------------------------------- Roberta B. Abrams, RNC, MA, LCCE is principal of RBA Consults, in Farmington Hills, Mich., and is on the adjunct nursing faculty at Madonna University. She may be contacted atRBAbrams@aol.com.