Chapter06 professional gatekeeping

CHAPTER SIX
Professional Gatekeeping
as a Function of
Role Fidelity

Edited by Brenda Holmes MSN/Ed, RN

ELEMENTS OF A PROFESSION
 Being professional vs. being a member of a
profession

Learning. All rights reserved.
Copyright ©2009 Delmar, Cengage
 Historical criteria for a profession
 Specialized body of knowledge
 Education standards
 Practice standards
 Professional etiquette which is your behavior that is
expected in the workplace
 Code of Ethics

 Self-regulating
 Fiduciary relationship with those served

PROFESSIONAL CODES OF ETHICS

 An important tool for self-regulation found in most health
care specialties
HOWEVER

 An all encompassing code of ethics, which covers every
conceivable ethical problem, does not exist
 Common problems:

 Vagueness as to duties and prohibitions
 Incompleteness to duties
 Excessive concern with promotion and prestige of
profession
 Vagueness in regard to self-regulation and peer
enforcement
 Excessive concern with financial and business interest

PROFESSIONAL CODE OF ETHICS
 Obligations
 To be a peer to others on a health care team

All rights reserved.
Copyright ©2009 Delmar, Cengage Learning.
 Can be seen as gatekeeping functions whereby you look out
for the interests of the profession
 Gatekeeping: comes as a result of professional obligations

and training
 Whole series of activities needed to protect the profession
those who would misuse the appropriate functions for the
specialty
 Monitoring system
Sense of collegiality and mutual support


 Flow naturally as a result of our professional obligations

and educations

PROFESSIONAL CODES OF
ETHICS (CONTINUED)
 Review the professional code of ethics for your specialty
(Do an internet research for CNA code of ethics or code of
ethics for your profession)


DISPARAGEMENT OF PROFESSIONAL
COLLEAGUES

 Disparagement
 Definition: belittle or criticize the skill, knowledge, or
qualification of another professional

 Many of us have heard of Cain’s questioned about “Am I

my brother’s keeper?”
 Health care you are “brother’s keeper”

 Responsible for our actions but also charged with the duty to
ensure that the rest of the health team is practicing
appropriately
 Need to protect patients from exploitation, regulatory
licensing mechanisms, legal remedies, and peer review
system
 Code of ethics
 Not only ethical rules but symbolizes that this group of

professionals is differentiating itself from the broader
group of occupations and technical careers
 Characteristic: generate a code of ethics and self-

regulating

CONFLICT OF INTEREST
 Fiduciary relationship
 Special relationship of loyalty and responsibility between
the patient and practitioner
 Practitioner will practice with good faith and candor

 Patient has the right to believe that the practitioner will
maintain a higher level of accountability in regard to
health care
 Conflicts of interest where patient-interests are
served
 Owning a health care supply business can be considered
conflict of interest if any health care professional
recommends their business. This is called joint venture i.e
part owner to a nursing facility.
 Caring for your own family in a health care facility
 Does intent make the difference?
 Rule of thumb: due to emotional conflict, many practitioner are
advised not to care for family and family members.

SEXUAL MISCONDUCT
 Sexual relations between practitioners and
patients

 Basic principles involved
 Considered unethical nor condonable
 Effects on therapeutic relationship
 Places the practitioner in the advantage in the critical areas
and personal vulnerability
 Intimate relationship of roles and can be powerful and

intense for both
 As soon as the practitioner feels like there is a
potential misunderstanding, it is time to end the
professional relationship

SCOPE OF PRACTICE
 Scope of practice
 Definition: Tasks that are included within the practice of a
specialty (legal regulations that allow practice within a

state; determination of questions regarding role-fidelity)
 Role-fidelity: requires that we remain within our scope of
legitimate practice.
 Problem of role evolution, for example, nursing
 Legislated practice acts
 General elements
 Scope of professional practice
 Requirements and qualifications for licensure
 Exemptions
 Grounds for administrative action
 Creation of an examination board and processes
 Penalties and sanction for unauthorized practice
 Legal sanctions

IMPAIRED COLLEAGUES
 Basic problem
 6-8% nurses in the US today are addicted to drugs/or
alcohol

 In one state, 90% of the disciplinary hearings within
the state were related to substance abuse
 Rationale for a duty to act:
 Protection of patients
 You are the patient’s advocate in which you can mediate
patient’s problems and complaints in relation to health care
 Reporting an impaired colleagues, is for the safety of a

patient
 Protection of specialty
 Protection of colleague
 Protection of institution

STEPS IN PROBLEM SOLVING
1. Problem sensing – gather and review facts
2. Formulate and state problem
List solutions of initial credibility

3.
4. Evaluate consequences to individuals involved
5. Evaluate solutions in regard to basic principles

STEPS IN PROBLEM
SOLVING
(CONTINUED)

1. Select solution
2. Prepare a defense


WHISTLE-BLOWING
 Definition:
 where the colleague or institution is reported for misconduct.
 A process of gatekeeping, a function of role duty and
professionalism that cannot be ignored

 In nursing facility:
 Office of Long-Term Care

 Ombudsman (patient advocate and staff)

 Downside
 Harassment, avoidance, demotion, termination
 What principles are involved?
 Everyone that is involved
 Making the decision
 Elements to consider
 Understand that whistle-blowing is high risk, lonely, and rarely
appreciated
 Process
 Clear and concise documentation and information
 Follow facility protocol and chain of command

INSTITUTIONAL ETHICS
COMMITTEE
 Definition:
 As an interdisciplinary body of health care providers,
community representatives, and nonmedical professionals

 Membership
 Include: physicians, nurses, social workers, philosophers,
laypersons, lawyer, administrators, and religious leaders
 Common functions:
 Policy and procedure development
 Educational role
 Case consultation
 Retrospective case review
 Decision making not function of IEC

KEY CONCEPTS
 Key elements of a profession
 Codes of ethics as important statements of self-

regulation
 Problems associated with disparagement of
colleagues

KEY CONCEPTS (CONTINUED)
 Problems associated with sexual misconduct with
patients

 Problems associated with conflicts of interests

 Functions of institutional ethics committee

 Requirements for role fidelity

DISCUSSION
 Discuss case study:
 Is There a Duty to Lie?

All rights reserved.
Copyright ©2009 Delmar, Cengage Learning.
 Questions1, 2, 3, 4
 An Old Friend, a New Relationship.
 Questions 1, 2, 3

Chapter06 professional gatekeeping

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Destacado

Destacado (7)

Similar a Chapter06 professional gatekeeping

Similar a Chapter06 professional gatekeeping (20)

Más de bholmes

Más de bholmes (20)

Último

Último (20)

Chapter06 professional gatekeeping