Law and Jurisprudence in Nursing Practice Three Basic liabilities in the Nursing Practice are: Civil payment of money;

; damages Criminal - imprisonment Administrative disciplinary action Civil Action 2 Types of Civil Liability : 1. Culpa Contractual 2. Culpa Aquiliana Culpa contractual ( breach of contract) - when a nurse is contractually obligated to perform a particular health service or intervention to a patient and caused death or injury to the latter Contract ( Art. 1305, Civil Code) - is a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to do some service. Culpa (Tort/Quasi-delict) Aquiliana

Culpa- aquiliana - absence of contractual relationship, a nurse may be liable for damages or injuries arising from negligent conduct It is a liability which arises from breach of a duty to any person fixed by the laws and such breach constitutes violation of a private legal right, without any contract

Criminal Action - Arises when a person perpetrates a crime or violates a special penal law or local government ordinance Felony- violations of crimes listed under the Revised Penal Code; crimes Mala- in se (deceit/dolo) Offense violation of a Special law; crimes Mala prohibita Infraction violation of an Ordinance Criminal Negligence- commission of a crime through fault ( culpa) Criminal Negligence - also called Imprudence - a kind of negligence suit which arises from the failure of the nurse or health care professional to apply to his profession that degree of care and skill which is ordinarily employed by his profession under similar conditions - may also pertain to a criminal action for malpractice against a nurse Administrative - An administrative Offense means every act or omission which amounts to, or constitutes, any ground for disciplinary action - An administrative disciplinary action against a nurse may arise from an administrative offense or any ground for Disciplinary action - For purposes of determining the administrative liability of a nurse, it is important to know whether he/she is employed in government or private hospitals/ institutions Government complaints against nurses may be filed at the Civil Service Commission, Ombudsman, Head of Government Office (Mayor/Governor)

Private filed with the private employer/hospitals

Contracts - A meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service Requisites of a Contract 1. Object certain - which is the subject matter of the contract 2. Cause of the obligation - which is established (Art 1318 Civil Code ) 3. Consent Consent -Manifested by the meeting of the offer and the acceptance upon the thing and the cause which constitute the contract -Approval of what is proposed by another -May be express or implied -Should not be given through mistake, violence, intimidation, undue influence or fraud Object - Must be within the commerce of man - Must be licit, or not contrary to law, morals, good customs, public policy or public order - Must be possible - Must be determinate as to its kind Cause -the why of the contract

- The essential reason which impels the into the agreement

contracting parties to enter

Breach of Contract - Unjustified failure to perform all or part of the contractual duty - If the breach is substantial, the entire agreement may be broken and damages may result - If only part of the contract is breached, the remaining part of the contract maybe in effect

Employment Contract -Need not be in writing - Oral contracts though can cause problems since memories fail Criminal negligence- committed by means of fault or culpa Mala in se committed by means of dolo or deceit (murder, theft, adultery,abortion) Mala prohibita those which are punished by special laws ( dangerous drugs law, illegal possession of firearms, anti-fencing law) Kinds of Criminal Negligence Reckless imprudence- doing or failing to do an act resulting to injuries or death due to an inexcusable lack of precaution Simple imprudence is a mere lack of precaution in a situation where the threatened harm is not immediate or the impending danger is not openly visible or manifest Negligence - The omission of that degree of diligence which is required by the nature of the obligation

- Failure to exercise the care that a prudent person usually exercises

Doctrine of Negligent Conduct - the nurse is liable for damages or injuries to the patient as a result of negligent performance or non-performance of the nurses obligation in the hospital

Malpractice -Defined as any professional misconduct or any unreasonable lack of skill or fidelity in the performance of professional duties -Improper or unethical conduct by a professional, resulting in harm, injury, or death of another - Practice contrary to established rules and standards Elements of Malpractice 1. Duty duty of a nurse to employ her training, care, and skill in the care of the patient commences at the time her employment is engaged by the patient 2. Breach breach of professional duties, skill, and care, or their improper performance by the nurse] 3. Damage or injury caused to the body or health of the patient 4. Proximate causation a) whether the nurses actions causes harm to the patient b) whether these actions are the proximate cause of the injury Misdemeanor - Applied to all crimes and offenses for which provided a particular name

the

law

has

not

Ex. Any person who practices nursing in a certificate of registration

the Philippines without

Criminal liability is incurred by: - Any person committing a felony although the wrongful act done be different from that which he intended; - Any person performing an act which should be an offense against persons or property, were it not for inherent impossibility of its accomplishment or on account of the employment of inadequate or ineffectual means. Classification according to Gravity Grave felonies- those which the law attaches the capital punishment (death) or periods which have the penalty of imprisonment from 6 years and 1 day to life imprisonment, or a fine exceeding P 6,000.00 Less Grave - those which the law punishes penalties correctional, with imprisonment of 1 month and 1 day to 6 years or fine not exceeding Php 6,000.00 but not less than Php 200.00 - Light - 1 day to 30 days or fine of not both that are

exceeding Php 200.00 or

Justifying Circumstances - the act/crime of the person is in accordance with the law; person is free from both criminal and civil liability

1. Self-Defense 2. Defense of Relatives 3. Defense of Stranger 4. Avoidance of Greater Evil or Injury 5. Fulfillment of Duty or Lawful Exercise of Office

Exempting Circumstances - grounds for exemption from punishment because there is lacking in the offender any of the conditions which makes the act voluntary (lack of intelligence, freedom of action or intent) 1. Insanity 2. Person under 9 years of age 3. Person over 9 years and under 15 years without discernment (mental capacity to appreciate the consequences of an act) 4. Person who acts under the compulsion of an irresistible force 5. Accident without fault or intention of causing it Mitigating Circumstances - circumstances which does not entirely free the offender from criminal liability but only reduces the penalty 1. Under 18 or over 70 years old 2. No intention to commit so grave a wrong 3. Provocation or threat 4. Passion (acted upon impulse) 5. Surrender and confession of guilt

Aggravating Circumstances - increase the penalty of the offense 1. Taking advantage of public position

2. Crime is committed in the presence of public authorities 3. Crime is committed in the palace of the Chief Executive 4. Crime is committed in the nighttime or in an uninhabited place 5. Crime is committed on the occasion of an earthquake, epidemic, shipwreck or calamity 6. Crime is committed with the aid of armed men 7. Crime be committed in consideration of a price, reward, or promise 8. The act be committed with evident premeditation 9. Superior strength 10. Means are employed to weaken the defense 11. That as a means to the commission of a crime, a wall, roof, door, or window is broken 12. Crime is committed by means of motor vehicles, airships, or other similar means

Other criminal actions and offenses Parricide - the highest form of destruction of human life; committed when one kills his father, mother or child, whether legitimate or illegitimate, or any of his ascendants or descendants, or his spouse Murder- committed when a person kills another, other than his father, mother, or child, or any of his ascendants or descendants, or his spouse, and which killing is attended by treachery, abuse of superiority, employment of means to weaken defense, evident premeditation, price, reward or promise and other qualifying circumstances Homicide- the killing of a human being which is neither parricide nor murder.

Infanticide - the killing of any child less than three days old, whether the killer is the parent or grandparent, or any relative of the child, or even a stranger

Abortionintentional- intent is present; the offender acted purposely to expel the fetus to bring about the abortion; unintentional- not intended but violence inflicted upon the pregnant woman is intended; unintentional abortion through reckless imprudence - the violence is due to negligence, imprudence, lack of foresight or lack of skill Giving Assistance to Suicide - Assisting another to commit suicide to the killing himself

the extent of doing

Illegal Detention - May arise in the enforcement of quarantine regulations; isolation of patients - Not allowing patients to leave the hospital if not cleared with payable account Simulation of Birth Crime against the civil status of persons punishable acts: 1) substitute one child for another or who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status 2) Any physician or surgeon or public officer who in violation of the duties of his profession or office shall cooperate in the commission of the crime

Rapetraditional view: carnal knowledge of a woman against her will sexual assault: committed when (1) penis inserted into the anal orifice of a male or female; (2) an instrument or object is inserted into the genital or anal orifice

Sexual harassment is committed in the work place, school, or training environment, by someone who has authority, influence, or moral ascendancy over the victim. - Committed by the former who demands, requests or otherwise requires any sexual favor from the latter, regardless of whether such demand, request or requirement for submission is accepted Mutilation - is the lopping or clipping off of some parts of the body resulting to the deprivation, of some essential organs for reproduction Physical Injury - committed when a person wounds, beats, or assaults another resulting to serious, less serious or slight injuries Physical Injuries Serious - ill or incapacitated for labor for any part of the body Less serious - incapacity lasted 10 days or attention during said period more than 30 days, or lost

more/

required

medical

Slight - incapacitated from 1 9 days

Wills - An act whereby a person is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his/her estates or properties, to take effect after his/her death (Art. 783, New Civil Code) Decedent a person whose property is transmitted through succession whether or not he left a will; if he left a will, he is called a testator

Succession - a mode of acquisition by virtue of which the property, rights, and obligations to extent of the value of the inheritance of a person, are transmitted through his death to another either by will or by operation of law. Testamentary Capacity the capacity to make or execute a will Requirements: At least 18 years of age Sound mind Two kinds of wills 1) Notarial wills signed by the testator himself or by the testators name written by another person in his presence and by his express direction - requires an attestation clause and an acknowledgement before a notary public

- needs at least 3 credible witnesses to testify that the testator signed the will Requirements for Witnesses to Notarial Wills 1) Of sound mind 2) Able to read and write 3) Not blind, deaf or dumb 4) At least 18 years old 5) Domiciled in the Philippines 6) Has not been convicted of falsification of document or perjury 2) Holographic will a will which is entirely written, dated, and signed by the testator - does not need an attestation or acknowledgement - does not need 3 witnesses, as long as one witness can prove that the signature belongs to the testator

JURISPRUDENTIAL DOCTRINES 1) Accountability the nurse is responsible for her own acts as well as those that affect her patients in relation to the care that is given to the latter 2) Respondeat superior let the master answer for the acts of his subordinates - the negligence of the employee is presumed to be the negligence of the employer 3) Bonus pater familias good father of a family

- the employer becomes liable on his own upon a finding that he has been negligent in the selection and supervision of his employees 4) Res ipsa loquitor - the thing or transaction speaks for itself - the injury itself is a proof of negligence 5) Damnum absque injuria although there damage, there was no legal injury was physical

6) Force majeure an act of God - an event which is unforeseen or inevitable which causes damage or injury to a patient may exempt a nurse from any criminal liability 7) Nolo Contendere - a plea of guilty or a plea of no contest - considered as an admission of guilt for a 8) Malfeasance, misfeasance, nonfeasance

crime charged

Malfeasance the performance of some act which ought not to be done (e.g. insertion of IV w/out training) Misfeasance the improper performance of some act which might lawfully be done (e.g. NGT gavage w/out checking placement of NGT tube) Nonfeasance the omission of some act which ought to be performed (e.g. failure to administer O2 therapy order) 9) Doctrine of Informed Consent two parts of the consent: a) information full disclosure

b) consent must be voluntary - based on the principle that every human being has the right to determine what shall be done with his own body Essentials Elements of Informed Consent 1) the diagnosis and explanation of the condition 2) fair explanation of the procedures to be done and used and the consequences 3) a description of alternative treatments or procedures 4) a description of the benefits to be expected 5) materials rights if any 6) the prognosis, if the recommended care or procedure, is refused Who can give Consent? - patient gives consent on his own behalf - if incompetent or physically unable, consent must from another who is authorized to give it in his behalf

be

taken

Emergency Situation - during an emergency situation, no consent is necessary because inaction at such time may cause greater injury 10) Doctors order rule - may be made verbally or in writing - it is legally safe to follow a written order because the physician cannot deny what he has written or signed Telephone Order - there are legal risks in telephone orders; they may be misunderstood or misinterpreted by the receiving nurse; leads to serious errors - Doctors should limit telephone orders to extreme

emergency situations where there is no alternative - the nurse should read back the order to the physician and make certain the order has been correctly written w/in 24 hours - nurse should sign the name of the doctor per her own and note the time the order was made 11) Nurse as a witness rule - as a witness, a nurse can only testify on matters he/she has direct or personal knowledge of - a nurse can be an ordinary or expert witness 12) Hospital records as evidence

Medical Records - supplies rich material for medical and nursing research (scientific) - serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of the patient and his management - record fully, accurately, legibly, and promptly their observations NOTE: If it was not charted, it was not observed or done Charting Done by Nursing Students - when a nurse or clinical instructor countersigns the charting of a nursing student, he/she attests that he/she has personal knowledge of information and that such is accurate and authentic

13) Duties of Doctors - a physician who holds himself out as a specialist should be held to the standard of care and skill of the average member of the profession practicing the specialty

14) Captain of the Ship Doctrine - the head surgeon is made liable for everything that goes wrong within the four corners of the operating room

15) Doctors are not Warrantors principle - physicians are not warrantors of cures or insurers against personal injuries or death of the patient

16) Liability of Hospitals and consultants - there is no employer-employee relationship between the hospital and a physician admitted in the said hospitals medical staff - principle of respondeat superior will not apply 17) Legal Risks for Defective Equipment - duty of the nurse is to make sure that the equipment used in procedures and treatments is not defective - document if there is improper functioning of equipment

POINTS TO OBSERVE IN ORDER TO AVOID CRIMINAL LIABILITY

1. Be very familiar with the Philippine Nursing Law 2. Beware of laws that affect nursing practice 3. At the start of employment, get a copy of your job description, the agencys rules, regulations, and policies 4. Upgrade your skills and competence 5. Accept only such responsibility that is within the scope of your employment and your job description 6. Do not delegate your responsibility to other 7. Determine whether your subordinates are competent in the work you are assigning them 8. Develop good interpersonal relationships with your co-workers, supervisors, peers, or subordinates 9. Consult your superiors for problems that may be too big to handle 10. Verify orders that are not clear to you or those that seem to be erroneous 11. The doctors should be informed about the patients conditions 12. Keep in mind the value and necessity of keeping accurate and adequate records 13. Patients are entitled to an informed consent

Other Related Laws 1) Proclamation No. 539 (Oct 17, 1958) of October every year as Nurses Week declared the last week

2) RA 6425 Dangerous Drugs Act; prohibited the sale, administration, delivery, distribution, and transportation of prohibited drugs 3) RA 9262 Violence against women and their Children Act

4) Letter of Instruction 47 integration of family planning in the curriculum of schools of nursing, medicine, midwifery, and allied health sciences 5) PD 965 requires couples intending to get married to undergo family planning counseling 6) RA 4226 Hospital Licensure Act; requires all hospitals in the Phils to be licensed 7) PD 442 Labor Code of the Phils 8) RA 6675 Generics Act of 1988 9) RA 7160 Local Government Code; transfers responsibilities for

delivery of basic services from the national govt to the local govt units 10) RA 7600 Rooming-in and Breastfeeding Act of 1992 Professional adjustment -The growth of the whole individual and the development of all his capacities- physical, mental, emotional, social, and spiritual. - The preparation of a student nurse for the responsibilities of professional and social life, by the development of her capacities in a way that would make him/her fit to enter upon the practice of nursing What is a profession? A profession is a calling that requires special knowledge, skill and preparation. (Kozier) It is governed by its own code of ethics. Its ideal is public service, not monetary gain.(Dionisio et al.)

Characteristics of a Profession 1. Systematic theory and knowledge base theory- fund of knowledge that has been organized into a consistent system from which the skills that characterize a profession flow from.. 2.Authority 3. Community sanction 4. Code of ethics 5. Professional culture

Differences between an occupation and a profession: OCCUPATION Training may occur on the job Length of training varies. Relies largely on experience or trial and error to guide decision making Values, ethics, beliefs not prominent features of preparation. Commitment and personal identification vary. Workers are supervised. People often change jobs. Material reward is main motivation. Accountability rests with employer.

PROFESSION Education in college or university Education is prolonged. Science or theoretical constructs to guide decision making Are strong. Are autonomous. Unlikely to change professions. Commitment transcends material reward.

Rests with the individual. Values, ethics and beliefs are prominent features of preparation.

ANA standards of professional performance 1.The RN systematically enhances the quality and effectiveness of nursing practice. 2.The RN attains knowledge and competency that reflects current nursing practice, 3.The RN evaluates ones own practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. 4.The RN interacts with and contributes to the professional development of peers and colleagues. 5.The RN collaborates with patient, family and others in the conduct of nursing practice. 6.The RN integrates ethical provisions in all areas of practice. 7.The RN integrates research findings into practice. 8.The RN considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services. 9.The RN provides leadership in the professional practice setting and the profession. Functions of a Nurse Caregiver help to regain health, maximal level of independent function through the healing process. Advocate - protect the clients human and legal rights, provide assistance in asserting those rights if the need arises.

Educator explain concepts and facts about health, demonstrate procedures, reinforce learning or behavior , evaluate clients progress. Communicator - Quality communication is critical in meeting the needs of individuals, families , and communities. Manager Coordinates of nursing staff, personnel, policy and budgetary responsibilities, evaluate performance goals, monitoring professional standards of practice, recruiting and hiring, staff development and CE, evaluating employees, and implements quality improvement. Roles of the Professional Nurse Care Provider Communicator / Helper Teacher Counselor Client Advocate Change Agent Leader Manager Researcher Career Roles Nurse Researcher Nurse educator Military Nurse Industrial Nurse Private Duty nurse Office nurse Nurse Generalist

Nurse Clinician Nurse Practitioner Nurse Specialist Nursing Administrator Advanced Practice Nursing a. Clinical nurse specialist (CNS) -An APN with nursing expertise in specialized area of practice / or with any field of disease and may work in any practice setting usually in a hospital . b. Nurse practitioner - Provides health care usually in the OPD, ambulatory care or community -based setting. Categories include acute care, adult , family, pediatric, womens, geriatric. - Manage self-limiting and chronic stable medical conditions. C. Certified nurse-midwife (CNM) - A registered nurse who is also educated and certified as midwife. - independent care for women in normal pregnancy, labor and delivery; for the newborn, gynecological services and family planning. D. Certified nurse-anesthetist (CRNA) - A registered nurse with advanced training in nurse anesthesia program; provide surgical anesthesia under the guidance /supervision of the anesthesiologist. Basic Values of a Nurse: ADVOCACY -For the safety, health and rights of clients.

-Reporting of any occurrence of incompetent, unethical, illegal or impaired practice by any health care member that has the potential to affect the clients health or safety. RESPONSIBILITY Willingness to respect obligations and to follow through on promises. ACCOUNTABILITY Ability to answer for ones own actions to your clients or your employer CONFIDENTIALITY Confidential protection of clients personal health information without diminishing access to quality care Cannot copy or forward medical records without client consent; cannot share clients lab results, diagnosis, prognosis unless necessary in the course of care

Nursing Stereotypes (Huston, 2006) 1. Angel of Mercy - From Florence Nightingale, 1930s depiction of nursing as a holy vocation. - Demonstration of supreme emotional strength, doing everything to save lives at a risk to oneself.( movie The English Patient) - The angel is compliant, willing, caring and dedicated. 2. Love Interest

- Started in 1930-1940s when nursing was a prestigious profession, requiring intelligence, capability, dedication to care-giving unless she met a husband (usually a physician) - Depictions of romantic relationships between nurses and doctors continue however most are not love interests but sexual liaisons. 3. Sex bombshell/naughty nurse - Nurses have been portrayed in motion pictures and televisions as sexual mascots in mini skirts, low cut tops, high heels fulfilling someone elses sexual fantasies instead of caring for patients. 4. Hand Maiden to the Physician - The most pervasive stereotype where the nurse simply serves as an adoring backdrop to the omnipotent physician, demonstrating little, if any, independent thought or action. - The nurse is pictured as obedient, permissive, conforming, flexible and serene (Kalisch and Kalisch, 1982) 5. Battle Axe - A picture of an overweight, authoritarian senior nurse who struts around with an air of self-importance, making the junior nurses cry and the patients quake under their sheets. 6. Male Nurses Stereotypes -Male nurses are homosexuals/effeminate -Male nurses are non-achievers for going into nursing rather than another occupation such as medicine or physiotherapy.

-Male nurses were characterized as being lazy, career driven, preferring technical rather than caring tasks, and disproportionately used for manual work such as lifting patients. ( Young, 2002)

Consequences of Stereotypes -Recruitment challenge -Threat to the collective identity of nurses -Threat to the self esteem of nurses Changing the Nursings Image 1.Finding a voice in the press. 2.Reclaiming the title of Nurse. 3. Positive Talk by Nurses, About Nursing. 4. Emphasizing the uniqueness of Nursing. 5. Participating in the political arena. 6. Corporate initiatives and coalition efforts. PROFESSIONAL POWER derived from latin verb potere- to be able - enables the individual or a group to accomplish goals - gives the individual the potential to change the attitudes and behaviors of others

Factors contributing to Powerlessness in Nursing (Huston , 2006) -Oppression of Nurses as a group.

-Nursings failure to fully align with the feminist movement. -Limited collective action by nurses. -The socialization of women to view power and politics negatively. -Inadequate recognition of nursing as an educated profession with EBP. -The professions history of being reactive rather than proactive in national policy-making. ACTION PLAN 1. Place more nurses in positions that influence public policy. 2. Nurses must stop acting like victims- if a nurse is unhappy in nursing, he needs to address what is wrong, rather than whine about nursing and act like a victim. 3. Become better informed about all health care policy efforts. COMPETENCE Competence- application of knowledge and the interpersonal, decision making and skills expected for the nurses practice role within the context of public health, welfare and safety. Assumptions Regarding Continuing Competence (ANA 2000) The purpose is the protection of the public and advancement of the profession through professional development. The public has the right to expect competence throughout the nurses careers. Any process of competency assurance must be shaped and guided by the profession of nursing. Assurance of continuing competence is a shared responsibility of the profession, regulatory bodies, organizations,& individuals

Assurance of Provider competence PROFESSIONAL LICENSURE - a process by which a government agency grants permission to an individual to engage in a given profession upon finding that the applicant has attained the essential degree of competency necessary to perform a unique scope of practice. - define what is necessary for safe practice required for activities that are complex, require special knowledge, skill, and independent decision-making. - A licensed individual is deemed to have met the minimal competency standards. ISSUES: 1. Licensure mechanism has little relevance to the different competencies achieved in various types of education programs for nurses. 2. Reliability and validity of the exam Continuing Education Definition: a planned learning experience beyond basic nursing education, designed to promote knowledge, skills, and attitudes for the enhancement of nursing practice, thereby improving health care provided to the public.

Rationale: it is an obligation of every practicing nurse to maintain competency due to the rapid changes in the delivery of health care and the public demand for more extended and improved health care. - Nurses must actively participate in professional development and in CE to meet the increasing and ever-changing demands of the profession and community. ISSUES: 1. Seat time in continuing education programs does not guarantee learning. 2. Lack of courses for experts and specialists. CERTIFICATION - A type of credential that affords title protection, recognition of competence, - Protection of the public. Enables anyone to identify competent people more readily - aids the profession by encouraging and recognizing professional achievement - Recognizes specialization, enhances professionalism

Issues on Certification: 1. certification does not have an impact on patient outcomes 2. whether continuing competence can be assessed in a single certification exam 3. whether recertification should be by licensure and not by completion of CE

REFLECTIVE PRACTICE - A self-regulatory assessment of ones practice identity and seeking learning opportunities to promote continued competence. - Portfolios allows an individual to record items or challenges of learning that are unique for each individual. Documents professional growth and career paths. Portfolios may contain: Videos Transcripts, licenses, awards Recommendation letters, certificates of recommendation Newspaper clippings about ones abilities Publications Sample academic/professional output Other artifacts / photographs. Narrative self reflection of practice ISSUES: 1. Reform is better than recorded competence. 2. Portfolios can be discoverable evidences for law suits. SOCIALIZATION The process by which a person acquires the technical skills of his or her society, the knowledge of the kinds of behavior that are acceptable in society, and the attitudes and values that make conformity with social rules personally meaningful and gratifying.

NEGATIVE SOCIALIZATION Horizontal Violence Bullying, Harassment, Verbal abuse, Intimidation Not all nurses are interested in the development of others or the profession Inappropriate workplace relationship

POSITIVE SOCIALIZATION Mentoring and empowerment Mentoring an intense , positive, exclusive, one on-one relationship between an experienced professional and a less experienced novice. Characteristics of an effective mentor positive attitude, caring towards others, experienced practitioner, good communicator, dedicated to learning, worthy of trust and admiration. (Roberts 2003) Stages of Mentor-Mentee Relationship 1. Selecting a mentor and defining expectations 2. Development of Role Competencies 3. Growing Independence 4. The Dissolution of the relationship Stages of Nursing Expertise (Benner, 2001) 1. NOVICE - Beginning nursing student, or any nurse entering a situation in which there is no previous level of experience. - The learner learns via a specific set of rules, protocols or procedures,

which are usually stepwise and linear. - Ability is extremely limited; Inflexible 2. ADVANCED BEGINNER - A nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. 3. Competent - A nurse who has been in the same clinical position for 2-3 years. - The nurse understands the organization; is a competent practitioner who is able to anticipate nursing care and long-range goals - Usually has experience with all types of psychomotor skills required by a specific group of clients; knows how to prioritize - Lacks the speed and flexibility of a proficient nurse. 4. Proficient - A nurse with greater than 2-3 years of experience in the same clinical position. - The nurse perceives the clients situation as a whole, able to assess the entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. - Focuses on managing care as opposed to managing and performing skills.

5. Expert - A nurse with diverse experience; - able to zero in on the problem and focus on multiple dimensions of the situation. - Skilled at identifying client-centered problems and problems related to the health care system - Highly skilled analytical ability that can be transferred to situations

JOB APPLICATIONS Resume making Letter Writing Job Interview

Resume or Curriculum Vitae- a summary of personal information relevant to the job you seek. It lists your accomplishments and experiences in a way that tells employers who you are and what you can contribute to their enterprise. Its purpose is to impress a potential employer and get you an interview. Types of Resume Chronological Resume- Positions are described beginning with the present or most recent regardless of how relevant they are. Functional Resume- Emphasizes experiences and skills according to the writers priority on the value of experiences.

Combination Resume Targeted Resume- focused on achievements Electronic Resume/Scannable Resume - uses key words that describe what you can do. Resume Requirements Neat, professional tone/appearance No negative information All words spelled correctly Brief content, concise Use font between 10-14 May use bold font; avoid underlining words. Use white paper to maximize contrast Use portrait mode All information is the truth Evidence of what the candidate has to offer the employer

Application Letters Consider the following: You want a certain position You are fit for it by: -your education -your experience -you want the position for a reason -you tell your reader something about yourself -secure action

What makes a good cover letter? No spelling or typing errors. Address it to the person who can hire you. Write it in your own words. Be natural. Show that you know something about the company and the industry. Use terms and phrases that are meaningful to the employer Checklist for an application letter Length one page of 3-4 paragraphs. High quality Paper white; substance 20-25 Font style Times new Roman, Helvetica, Arial Font size 10-12 Print Laser printed or type-set. Balanced page- center letter; full or modified block style With current address and date Enclosures- resume, transcript, references (Enc. Or enclosures) after the signature block Beginning the letter: The opening sentences of the application letter should arouse the immediate attention of the reader. Good beginning sentences are direct and simply phrased. Poor: Replying to your recent advertisement I wish to apply for the position of nurse Better: In applying for the position of staff nurse, I offer my qualifications, which I believe, will meet your exacting requirements.

Ending the letter: End with a request for an interview rather than for the job itself. Give attention to the individuality and the force of ending. Avoid weak or hackneyed endings. Poor: If you think I can fill the position, I shall be glad to talk with you. Better: If my application convinced you of my ability, I welcome the opportunity to talk with you, that you may judge my qualifications further. The Interview This assessment of individual personality tells the interviewer about the candidates disposition, attitude, interests, and personality traits. It can be done as one-on-one or panel interview. Preparing for the interview 1.Remember to find out as much as possible about the company. 2.Find out as much as you can about the position. 3.Practice reviewing your strengths, skills and accomplishments. 4.Be aware of typical interview questions and practice your answers. 5.Prepare a list of questions for the employer to answer. 6.Have an idea of what the competitive salary is for the position and know your own salary requirements. 7.Collect any information you think you may need for the interview. 8.Select and prepare the proper clothing. 9.Prepare mentally and use the power of positive visualization. Interview Behavior

Good eye contact Appropriate body language Appropriate voice melody Active listening Good choice of words TELEPHONE INTERVIEWS Telephone dos Prepare yourself before calling Practice answering questions with a friend Prepare beforehand as you would for any interview Set up a daily plan Keep pen and paper handy for notes Keep a log of your activities Keep a smile on your face Time your call carefully Keep a record of your applications in a file next to the telephone Smile it comes through in your voice Use gestures as in normal conversation Be enthusiastic Sit in a comfortable chair Speak clearly Telephone Donts Dont drink a beverage, chew gum,smoke Allow background distractions or noises Sound as if you are reading a script

Speak too softly Talk too technical Rush though your presentation Interrupt your contact Act as if your contact cant see you Be overbearing Leave a message Say ah, er, hmm and other unnecessary expressions Resigning from a Job It is suggested that nurses keep their positions for at least two years if the position is acceptable to them. Think of the whole situation; seek assistance in decision-making; do self analysis Leave a friendly feeling towards superiors and co-workers. Use prudence in accepting another position. Give advance notice. (1-6 months) Leave with a clean record in the most gracious professional manner. DURA LEX SED LEX - The law is harsh but it is the Law