Please read the discussion board post and complete a full 1-page peer review (response). Also, please elaborate on the discussion and follow the grading rubric. ***Please do not use the same words from the original order #121676*** I do not need a title page. I have attached the discussion board post and grading rubric as a file.
Question 1
The oncology inpatient unit has experienced a great amount of nursing staff turnover. In the last 6 months, five of the 22 permanent RN staff have left. In addition, the number of medication errors for the unit has risen from an average of two per month to a high of 11 errors last month.
- How could you calculate whether there is a significant relationship between staffing and medication safety issues? (Chapter 9 #3)
- How would you explain this result to your chief financial officer (CFO) to request additional money to hire more permanent staff RNs? (Chapter 9#4)
Response
The first question explores how a nurse leader will compute to explore if a significant relationship exists between staffing and medication safety issues. Waxman (2018) recommends that the nurse leader compute the Pearson product-moment correlation coefficient to establish the number of temporary registered nurses compared to the number of medication errors documented in the past six months. Research shows that the Pearson product-moment correlation coefficient is utilized to assess the extent of the association between the linear associated variables—in this case, medication errors and nurse turnover. The Pearson product-moment correlation coefficient outcomes only depict the correlation scores and not the cause-and-effect dynamics (Puth et al., 2018). As such, Pearson product-moment correlation coefficient outcomes only show a quantifiable, directional relationship between medication error adverse events and nurse turnover (Humphreys et al., 2018). According to Waxman (2018), the Pearson product-moment correlation coefficient outcomes, in this case, in the context of r value, is +0.47. The +0.47 value shows a perfect extent or degree of association between medication errors and nurse burnout in the oncology inpatient unit.
Regarding the second question involving the r=+0.47 value outcome, the learner would explain the perfect positive and perfect negative correlation dynamics, which depict the meaning of the value scores as the outcome increases or decreases towards 1.00. The learner would explain that the Pearson r is the measure of the overall linear strength of the correlation relationship between nurse turnover and medication error variables. In this context, the value of the Pearson product-moment correlation coefficient varies between +1 and -1. When the outcome of the Pearson product-moment correlation coefficient lies around ±1, then it is estimated to be a perfect degree or extent of correlation association between two different variables (Schober et al., 2018). As the outcome of the r-value decreases towards zero, the association or correlation value will be weaker. The learner would show the high and robust correlation between medication errors and high nurse turnover in this context. This would indicate that inadequate staffing is strongly correlated with increased medication errors and hence the increased need for additional funds to hire more permanent staff registered nurses.
Question 2
You are the chief nursing executive for a small rural clinic that provides contraception services to low-income individuals. An insurer, providing care under the Affordable Care Act (ACA), has rejected paying the claims, stating that they are a not-for-profit religious organization and are not obliged to cover these services. You check your records and find that nonpayment for contraception places a significant financial burden on the clinic. These individuals do not have access to any other health care services in the region. (Chapter 10 #3)
- What are your first, second, and third actions according to priority?
- How do you justify this action based on legal and ethical guidelines?
Response
The first step would include a comprehensive Affordable Care Act insurance terms of service provision. Following a clear understanding of the insurer’s terms of service, the learner would write to the Affordable Care Act insurer to substantiate the claims that they are not obliged to cover contraception services and petition them to make an exception if their terms of care provision clauses support their actions. The last step would include creating a follow-up to petition the Affordable Care Act to provide contraception services or find alternative options to raise funds that can help in purchasing contraception services for low-income patients. According to medical ethics, the ethical principle of distributive justice emphasizes the need to distribute resources equally to patients fairly and ensure all patients are treated without discrimination or omission (Thomas, 2019). Also, the principle of non-maleficence holds that providers and insurers should strive to make decisions that do not harm patients. As such, distributive justice and non-maleficence justify the petition to the ACA insurers or design alternative sources of funds to purchase necessary contraception resources for these patients. These actions would aid in avoiding the high risk of sexually transmitted diseases and unnecessary burden for these patients in terms of unwanted pregnancies. In terms of legal guidelines, the providers and insurers have a duty of care in providing services—in which deliberate breach could result in a legal negligence lawsuit (Waxman, 2018). As such, the provider must petition the ACA or find alternative sources of funds to purchase the necessary resources to fund contraception services or risk being subjected to a medical negligence lawsuit.
References
Humphreys, R. K., Puth, M.-T., Neuhäuser, M., & Ruxton, G. D. (2018). Underestimation of Pearson’s product moment correlation statistic. Oecologia, 189(1), 1–7. https://doi.org/10.1007/s00442-018-4233-0
Puth, M.-T., Neuhäuser, M., & Ruxton, G. D. (2018). Effective use of Pearson’s product–moment correlation coefficient. Animal Behaviour, 93(45), 183–189. https://doi.org/10.1016/j.anbehav.2014.05.003
Schober, P., Boer, C., & Schwarte, L. A. (2018). Correlation coefficients: Appropriate use and interpretation. Anesthesia & Analgesia, 126(5), 1763–1768. https://doi.org/10.1213/ane.0000000000002864
Thomas, J. (2019). Ethical and legal issues in medical practice. American Journal of Urology, 25(3), 335–400. https://doi.org/10.4103/0970-1591.56191
Waxman, K. T. (Ed.). (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing Company.
| Discussion Board Initial Posting Rubric | |||||
| Criteria | Ratings | Pts | |||
| This criterion is linked to a Learning OutcomeRelevance to the topic or problem |
|
20 pts | |||
| This criterion is linked to a Learning OutcomeInsight and application of course concepts |
|
40 pts | |||
| This criterion is linked to a Learning OutcomeUse of evidence and support |
|
25 pts | |||
| This criterion is linked to a Learning OutcomeGrammar, Punctuation & APA |
|
15 pts | |||
| Total Points: 100 | |||||
DNPs on Research and Ethics: Response
Nurse leaders need to understand the laws that govern reimbursement and the ethically-appropriate interventions that they can take in situations where insurers have rejected to pay claims. They should strive to understand the insurers’ terms of services, including any exemptions that they might have (Waxman, 2018). In your discussion, you have proposed the need to petition the insurer to narrate its terms of service and make a petition that would require it to clearly state the exemptions that are preventing it from paying claims for contraception services. Although this will help the nurse practitioner to better understand that insurer’s position, it is important to note that it might fail to solve the problem at hand. For instance, the patients might be forced to use money from their own pockets to pay for contraceptive services. Additionally, the approach might fail to address the financial burden that the facility is currently facing due to nonpayment for contraception.
Failure by the insurer to pay insurance claims for contraception service places the nurse leader in a state of an ethical dilemma. Low-income individuals are facing financial challenges and are optimistic that enrolling in insurance programs under the Affordable Care Act will increase their access to healthcare services (Kominski et al., 2017). As Waxman (2018) explains, the ACA embraces the ethical principle of equity or justice. Therefore, any law that might exempt insurers from paying claims for healthcare services already delivered to patients violates the ethical principle of fairness by denying low-income patients important health services that they might need. There is an existing law in the United States exempting organizations or insurers with moral or religious objections from providing insurance coverage of contraception services (The Commonwealth Fund, 2020). In their advocacy roles, doctorally-prepared nurses should influence policy changes that will help to address barriers to healthcare access for low-income populations who are receiving contraception services.
References
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review of Public Health, 38, 489–505. https://doi.org/10.1146/annurev-publhealth-031816-044555
The Commonwealth Fund. (2020). Supreme court excuses organizations with religious or moral objections from covering workers’ birth control. https://www.commonwealthfund.org/blog/2020/supreme-court-excuses-organizations-religious-or-moral-objections-covering-workers-birth