discussion post 156

I am of the opinion that the state board of nursing should not put limitations on the number of hours worked by nurses. This is because there is already a nursing shortage in the industry and most nurses work overtime to make up for lapses in their unit and also to assist their coworkers when they are short, According to Wheatley (2017), “Nursing overtime is common in health care to accommodate staffing needs despite evidence that it increases the incidence of patient and nurse adverse effects”. Even though there are concerns about lack of sleep and inadequate recovery time in between shifts which are true, I believe each institution should try to regulate the amount of overtime worked in each facility. For example, at my hospital, we are not allowed to work more than 16 hours straight and there must be an eight-hour interval before the next shift. Nurses need the overtime from time to time to make extra money and also to cover shortages. Facilities need to regulate their staff to avoid the adverse effects as much as possible.

I will be more cognizant of professional boundaries than before even though I have been very careful in the past not to cross the boundary. Patients have always been treated by me in a professional manner and I have tried to keep it on that level with my patients. According to the Texas Board of Nursing Rule 217.11(1)(J), “Every nurse is responsible for knowing, recognizing, and maintaining the professional boundaries of the nurse-client relationship” (TBON, 2013). This is my responsibility as a nurse and I will do all that it takes to maintain it. According to Valente (2017), “Professional relationship guidelines must be applied with thoughtful consideration and nurses must monitor their emotions and reactions in these relationships”. Maintaining relationship boundaries is key and learning to let go when our work is done with a patient as nurses is needful.

One key thing I learned in this course is the nurse’s duty to the patient supercedes any rule or policy of any organization. That is a rule that will stay with me and guide my nursing practice in the future.

DISCUSSION POST 2 -MILINDA

I believe that the number of hours in a row should be limited, but not how many hours per week so much. For instance, our hospital will only allow you to work a maximum of 16 hours before you absolutely have to clock out and go home. I think this is the right call for sure. We have had people pick up a princess shift from 3-7pm, then continue on working their night shift schedule until 7am the next day, making for a full 16 hours. The people I have seen do this are completely wiped out and so tired. I don’t think there should be a weekly limit or cut off for overtime hours though as some people utilize overtime to support their families. Right now our hospital is overstaffed, and overtime is harder to come by these days. However, fatigue and lack of rest can cause a higher risk for more errors to occur. According to Townsend and Anderson (2013), “fatigue and sleep deprivation account for decreases in memory, vigilance, information processing, reaction time, and decision making” (Townsend & Anderson, 2013). All of these are very vital to bedside nursing as it’s so important to notice those critical values and symptoms in your patient that might warrant a higher level of care.

Do you think you will be more cognizant of professional boundary issues in your practice than you were prior to the course? Justify your thoughts with evidence-based research

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I don’t believe I’ll be more cognizant than I already had been previously. I feel that I am already aware of these issues and will continue to remain aware, but I wouldn’t say it changes anything for me necessarily. Setting boundaries with your patient is so important. We have had plenty of patients who try to manipulate to get what they want, and clear/consistent boundaries with those types of people are what works best. According to Benbow (2013), “nurses have a duty to set professional boundaries with patients, abide by those boundaries, and not violate them. Certain behaviors can be seen as red flags to crossing the line with boundaries set such as excessive self disclosure, secretive or defensive behavior, excessive patient attention, non-therapeutic relationships such as gift giving” (Benbow, 2013). I remember one particular lady on our floor as a patient was trying to pay our nurses. No one accepted the gifts of course, and it didn’t seem manipulative. She was having trouble figuring out how to thank us for the care she recieved and she wanted to tip everyone. We all graciously declined, but thanked her for the thought.