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DEFINITIONRegulation of nursing practice
Nursing practice act: legally defined and described regulations of nursing practice by an
administrative board such as state board of nurse examiners. These boards have the authority toregulate nursing practice and education within the state.
(Fedorka and Resnick, 2001)
REGULATORY MECHANISMS IN NURSING
Each state legislature has passed laws designed to enact the state nursing practice act by
describing the scope of nursing including licensure, credentialing, disciplinary procedure and
professional standards.
LICENSURE: - It is a legal permit that government agency grants to individuals to engagein practice of a profession and to use a particular title. It is meant o ensure that practising nurses
have met the minimum competencies set by the state to protect public.
For profession to obtain licence, 3 criteria must be satisfied-
There is a need to protect public safety and welfare. The occupation is clearly delineated as separate distinct areas of work. There is proper authority to assume obligations of licensing process.
Each state has also the power to revoke licenses in case of incompetency on the part of nurse
or in case of professional misconduct or committing crime such as use or sale of legal drugs etc.
Recent advances in health care delivery have led to establishment of new regulatory model
named the mutual recognition model which allows for multi state licensure. Another innovationis the interstate compact called Nurse Licensure Compact which is the mechanism used to create
mutual recognition among states.
CREDENTIALING: - A voluntary form of self-regulation process in which the nursing
profession maintains standards of practice and accountability for educational preparation of its
members.
Accreditation: most nursing boards establish educational requirements fornursing programs and continuing education courses within a given state. The
board usually requires that for a nursing program to be accredited it must meet
requirements established by National League for Nursing Accrediting
Commission (NLNAC) and Commission on collegiate Nursing Education
(CCNE). This helps ensure that students get a well rounded education and
patients are cared for by safe practitioners.
Certification: it is the voluntary practise of validating that an individual nursehas minimum standards of nursing competencies in speciality areas. To become
licensed as an advanced practise nurse, national certification is necessary.
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DISCIPLINARY PROCEDURES:
State boards commonly enforce requirements by establishing disciplinary procedures
followed unprofessional conduct by nurses. E.g. violation of nursing practise acts fraud and
deceit, unethical conduct.
STANDARDS OF PRACTICE:
Standards of care are the skills and learning possessed by the members of the profession.
They can be classified into two- internal and external.
Internal include the nurses job description, education, expertise and individual institutional
policies and procedures. External include nurse practice acts, professional organizations, federal
organizations and nursing speciality practice organizations.
REGULATORY BODIES
The regulatory bodies that define the laws and regulations in nursing practice are the
nursing council at the international, national, and state levels.
International council for nurses:
ICN was found in the year 1899 by Mrs. Bedford Fenwick, an English woman. It is the
oldest international association of professional women. In order to maintain regulations in nursing
practice, it opens membership for all self governing national nurses associations.
The main activities and accomplishments are publication of the code for nurses, the world
wide accepted definition of a nurse and the nurses Dilemma, abook of ethics. The Guidelinesfor National Nurses Associations in the Indian Nursing Yearbook, 1988-89 is one e.g. of how the
Council works to improve nursing education and practice.
FUNCTIONS
Improve the standards of nursing and the competence of nursing
To promote the development of strong national nurses association To serve as authoritative voice for nurses internationally To assist the national nurses association to improve the status of nurses
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Indian Nursing Council:
INC was established under the act of parliament known as INC act, 1947 followed a
recommendation made by the Bhore committee in 1946. The act was then amended in 1950 and
1957. The INC was constituted in 1949. Section 3(1) of INC act describes the constitution and
composition of the council.
INC has statutory obligations to see that the minimum standards which are prescribed arebeing met. In order to fulfil this function, schools of nursing are inspected and the conduct of
examinations is regulated. The council has the power to withdraw recognition if minimum
requirement are not met. The submission of annual report by the schools and colleges is another
means of regulating control to ensure that the minimum requirements laid down are met. It is an
autonomous body and its official relationship with the state is through state governments
INC is given authority to prescribe curricula for nursing education in all the states. INC
was also asked to provide registration of foreign nurses and the maintenance of the Indian nurses
register. Inc authorises state nurses registration councils and examining boards to issue qualify
certificates.
FUNCTIONS
To establish and monitor a uniform standard of nursing education by doing inspection ofthe institutions.
To recognize the qualifications for the purpose of registration and employment in Indiaand abroad.
To give approval for registration of Indian and Foreign Nurses possessing foreignqualification
To prescribe the syllabus & regulations for Nursing programs. Power to withdraw the recognition of qualification in case an institution fails to maintain
its standards that an institution recognized by a State Council
To advise the State Nursing Councils, Examining Boards, State Governments and CentralGovernment regarding Nursing Education in the Country.
State nursing councils:
Almost all the states in the country have a nursing council with its own registrar and is
responsible for the registration of nurses, midwives, health visitors and auxiliary nurses. Every
professional nurse who wishes to be active in nursing profession either here or abroad must be
registered with one of the state nurses registration council. The state council functions as the
official control of standards of nursing practice. It registers only those who have completed
recognized programmes of nursing education who meet requirements of competence and
character. This serves as a legal protection to the nurse and protects the public from incompetent
nursing practice or poor nursing care.
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Karnataka nursing council:
The functions include,
Regulation of the training programmes of the diploma, degree and post graduationcourses.
Supervision of the practice of the profession by its member. Granting recognition to the training institutions and periodical inspection. Prescribing syllabus and curriculum for various courses. Registration and granting certificate to qualified persons to practice their profession.
The procedure for registration is usually initiated by the nursing administration of the
respective institution. A nurse is qualified to register when they have completed the
recognized programme of nursing education and passed the qualifying exam (board exam)
conducted by the Rajiv Gandhi university. The university will issue a diploma or degree
certificate, which must be send with copies and a properly filled out application form to theregistrar of the Karnataka nurses registration council. When the name and correct data
have been entered in the state register, will be issue the Karnataka registration certificate
with registration number. This certificate is a legal proof of the registry and should be kept
with copies in a safe place. Application of the registration to a foreign is also channelled
through the state nurses registration council.
Rajiv Gandhi University of Health Sciences:
The RGUHS was established in 1988 as a premier health university in Karnataka.The university is the regulating body for all medical and allied courses in the state. There
are over 200 nursing colleges affiliated under this university and the university lays down
guidance for the curriculum to be followed, the revision of curriculum, scheme of
examinations, awarding of degree and all other related academic activities.
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COLLECTIVE BARGAININGDEFINITION:
Collective bargaining is an agreement between a single employer or an association
of employers on the one hand and a labour union on the other, which regulates the terms and
conditions of employment
(Tudwig Teller)
Collective bargaining is a process of discussion and negotiation between
two parties, one or both of whom is a group of persons acting in concest. More specifically it is
the procedure by which an employer or employers and a group of employees agree upon the
conditions of work
(The encyclopaedia of social science)
UNION/LABOUR ORGANIZATION:
An organization in which employees participate for the purpose of negotiating with
the employer about grievances, labour disagreement, wages, hours of work and conditions of
employment.
CHARACTERISTICKS OF LABOUR UNIONS:
Union certification- any seven persons can from a trade
Defining membership of the bargaining unit both union and employer attempt to
specify which worker classifications are eligible for membership in bargaining unit.
PREPARATION FOR COLLECTIVE BARGAINING:
Preparation should begin months before the contract talks. Chairperson should be establish and maintain pleasant relationship with union
representatives by treating them courteously in social situations, grievance hearing.
Obtain information from other nurse executives about union activities in neighbouringhealth agencies.
Review other labour contracts negotiating in other agencies to determine what type ofdemands were made by various worker categories.
Keep ongoing recording agencys employees grievances and analyse these beforenegotiation begins.
Research the wage salary structures of other health agencies in the community andcompare against agencies current wage package.
Should read the act to identify limitations.PROCESSES OF UNIONIZATION
The process of unionization consists of following steps:
Selection of a bargaining agent. Certification to contract.
Contract administration. The nurse managers role. Decertification.
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Selection of bargaining agent:
The process of establishing a union in any setting begins with the selection of
a bargaining agent certified to conduct labour negotiations for a group of individuals. This process
is known as a representative election and is presided over by the national labour relationship
board. For an election occurs, the union must demonstrate that interest is shown by at least 30% of
the employees affected by this action. Once the 30% level is reached, the union can petition the
national labour relations board to conduct an election. At the conclusion of this meeting the boardwill have determined three things:
- Who is eligible to participate in the union: - This is problematic issue and not easilyresolved, because registered nurses employed as staff nurses are eligible for
collective bargaining but registered nurses employed as management are not.
- Whether the signatories are employees of the organization.- A date for union election: - the election is conducted by the board within 45 days,
using a secret ballot. All individuals eligible for represent action by the union are
notified of the election time and date. On Election Day, eligible employees are asked
to choose not only whether they wish to be representatives of the union but alsowhich union they want to represent.
Many unions represent registered nurses in collective bargaining; therefore
the ballot may contain several choices for the bargaining agent. In addition to various state nurses
associations (SNAs), other major unions representing nurses are:
- American federation of, county and municipal employees (AFSCME).- Service employees international union (SEIU).
The election outcome is determined by the group receiving a simple majority of the
votes cast. The union winning this election certified to enter into contract negotiations with theemployer.
The process of selecting a bargaining agent produces a tense, emotional
climate that affects everyone in the organization. It is important for both nurse and managers and
staff nurses to remember that during this period, the rules of unfair labour practice apply. Staff
nurses also must be careful that their discussions regarding collective bargaining take place away
from the work site and not on work time.
Certificate to contract:
Certification by the National Labour Relations Board (NLRB) of a union to be the
bargaining agent does mean that a group of people have the right to enter into a contract with an
employer, a concept known as certification to contract.
The actual contract and its provision must be written and voted on by the union
membership a process that may take some time. Issues considered mandatory subjects of
bargaining are rates of pay, wages, hours of employment and grievance procedures.
Additionally, the contract may specify other areas provided that both parties agree
they should be included. These can include:
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A union among security clause. A management rights clause. Seniority. Fringe benefits. Layoff and reduction in work language. Floating procedure. Insurance. Retirement issues. Professional issues.
The contract is considered to be in effect when both management of the organization
and employees agree on its content. The final agreement is subject to a ratification vote by the
affected employees. Passage of the contract, or ratification, is obtained by a simple majority of
eligible members who vote.
Contract administration:
The role of administrating the contract then falls to an individual designated as the
union representative. The individual may be an employee of the union or a member of the nursing
staff. It is the duty of the union representative to provide fair and equal representation to all
members of the unit. The role of the union representative is explain the provisions of the contract
to the union membership and be available to help in the grievance process.
The nurse managers role:
The nurse manager in a health care organization where nurses are organized into acollective bargaining unit participates in resolving grievances, using the agreed upon grievance
procedure.
CLASSIFICATION OF GRIEVANCE:
Grievance can usually be classified as
o Those caused by misunderstanding.o Those caused by intentional contract violations.o Those caused by symptomatic problems outside the scope of the labour
agreement.
Grievance caused by a misunderstanding usually stem from circumstances surrounding the
grievance, a lack of familiarity with the contract or an inadequate labour agreement.
Intentional violation of a contract is usually an effort to capitalize on ambiguous contract
language or past practices.
Symptomatic grievances are simply a means for the employee to show dissatisfaction or
frustration and stem from the human element in management / labour relationship.
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THE GRIEVANCE PROCESS: an example;
The following steps comprise the typical grievance process:
Step 1:- the employee talks informally with her or his direct supervisor, usually as soon as
possible after the incident has occurred. A representative of bargaining agent is allowed to be
present. A written request for the next step is given to the immediate supervisor within ten work
days. The employee, supervisor, and agent will be present for any discussion.Step 2:- if the response to step 1 is not satisfactory, a written appeal may be submitted
within 10 work days to the director of nursing. The employee, agent, grievance chairperson and
the top nursing administrator or designs can be provided in 5 work days subsequent to these
meetings.
Step 3:- the employee, agent, grievance chairperson, nursing administrator and director of
human resources meet for discussion. The 10 and 5 day time limits for appeal and answer are
again observed.
Step 4:- the final step is arbitration, which is invoked when no solution suggested isacceptable. An arbitrator who is a neutral third party is selected and is present at these meetings.
The submission of grievance may be required within 15 days after step 3 is completed.
SUGGESTIONS HELPFUL IN HANDLING GRIEVANCE:
The objective of the grievance process is not to achieve conquest. You have to workwith one another after resolution of the grievance, so treat each other with courtesy
and respect.
Do not, whatever your position, allow disagreements or disputes among members ofyour team to be public. Expedience is a must; delaying tactics serve only to heighten emotions. However
allow time to consider the facts.
Stay objective: emotionalism usually leads to further problems. Implementing decisions or filing grievances requires planning. Get all the facts and
informations, evaluated and anticipates the other partys response. Seek guidancefrom those higher in administrative positions.
Never refuse to meet with the grievant representatives. The bargaining unit representative, though in a unique position, is not immune from
reprimand or discipline. Integral to bargaining are solutions that may also accommodate future changes and
needs.
Be prepared to give or take acceptable compromises and alternate solutions withinthe framework of the contract, no matter which party suggests them.
Pat formulas do not settle grievance or solve problems. Observe the time limits. If you do not, the bargaining unit may lose the right to
continue the grievance to the next level.
In adjusting a grievance, knowledge is very important. Gloating over a nursing is human but remember that you may lose the next one;
dont become overconfident.
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THE GRIEVANCE HEARING
In the grievance hearing, remember this key behaviour:
Put the grievant at ease. Do not interrupt or disagree. Listen openly and carefully. Discuss the problem calmly and with an open mind.
Get the story straight. Get all the facts ask logical questions. Consider the grievant view points Avoid snap judgements. Do not jump to conclusions Make an equitable decision, and then give it to the grievant promptly.
Decertification:
Occasionally, members of a particular may decide that the union they want or that
no union at all is needed. In such a case, the members of the bargaining unit have the right to
either change their union affiliation or remove the union by using a process known as
decertification. This process is essentially the same as that following by the NLRB for a
representation election.
TYPES OF STRIKES:
Jurisdictional recognition
Strikes strikes
Economic TYPES OF sympathy
Strikes STRIKES strikes
Illegal unfair
Strikes labour strikes
Economic strikes:
Employees attempt to get their employer to meet their demands by theirservices. An employ cannot be fired for participating in an economic strike but can be replaced.
Unfair labour strikes:
Result from an unfair labour practice by an employer or a union.
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Sympathy strikes:
Employees of one employer strike in support of another. Workers can refuse to cross to
picket lines.
Jurisdictional strike:
In jurisdictional strike there is a work stoppage over the assignment of work to two or more
unions. Employees may strike because the employer assigned a particular job to another union.
Recognition strikes:
It is a work stoppage to force an employer to bargain with a particular organisation.
Illegal strikes:
The category of illegal strike comprises violent strikes, boycott or secondary strikes and
wildcat or surprise strikes that are not authorised by the union.
ADVANTAGES AND DISADVANTAGES OF COLLECTIVE BARGAINING:
Advantages:
o Equalization of powero Viable grievance procedureo Equitable distribution of worko Professionalism promotedo Nurses control practice
Disadvantages:
o Adversary relationshipo Strikes may not be preventedo Leadership may be difficult to obtaino Unprofessional behaviouro Interference with management
MAJOR ISSUES IN COLLECTIVE BARGAINING FOR NURSES:
Unit determination:
The term unit determination refers to the decision. Making process the NLRB uses
to determine the composition of a given group for collective bargaining. In this process the NLRB
could use their discretion in determining unit composition because the guidelines given by
congress in 1974 amendments instructed that there be no undue unit proliferation.
Following passage of the 1974 amendments, the NLRB determined the composition
of each bargaining unit on a case by case basis. To meet the congressional mandate that there be
no undue unit proliferation, the NLRB adopted a standard to determine unit composition calledcommunity of interest.
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In 1984, the NLRB changed from a community of interest standard to a disparity of
interest standard.
Under the community of interest standard, the NLRB accepted any of 6 existing
units-registered nurses, other professionals, technical employees, service and maintenance
workers, business office clerical and guards.
Unclear the new disparity of interest standards, the NLRB recognised only 4 units-professionals, technical employees, service maintenance employees and guards.
Hospital management groups wanted to recognise only those unions composed of all
professionals, all non professionals and guards. This dispute resulted in the NLRB on September
1st, 1988 proposing a rule identifying 8 separate eligible bargaining units in health care:
o Registered nurseso Physicianso All professionals except registered nurseso Technical employeeso Guardso Non professional employeesAfter a number of legal challenges, these rules were eventually upheld by the U.S
Supreme Court in April 1991.
Labour management committees:
A popular development during the last decades in the formation labour management
committees. This allows staff nurses and nursing managers to communicate on a less formal basis
to help resolve potential or actual problem.
However institutions that use labour management committees may be in violation of
federal labour law. The national relations act defines a labour organisation as any organisation of
any kind or any agency or employee representation committee in which employees participate and
which exists or the purpose ofdealing with employees. Furthermore, the law defines one unfair
labour practise by the employer as being to dominate or interfere with the formation or
administration of any labour organisation or contribute financial or other support to it.
The recommendation made by the committee may or may not be implemented by
the organisation and may be subject to change in the future by the organisation without the
consent or consultation of the committees.
NURSES, UNIONS AND PROFESSIONAL ASSOCIATIONS:
Since its inception, the Americans Nurses association (ANA) has an active interest
in the economic security of nurses. Although it was useful in helping to shape the role of the
profession in supporting collective bargaining for nurses, the ANA did not officially adopt an
economic security programme that included collective bargaining until 1946. Since that time, the
ANA has actively promoted collective bargaining for nurses through the economic and general
welfare programme which currently called department of labour relations and work place
advocacy.
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ANA is a registered labour organisations but it does not engage in direct collective
bargaining. Although the ANA supports collective bargaining and takes an active role in
promoting collective bargaining, the SNAs have the freedom to independently decide their own
level of participation regarding collective bargaining. All the SNAs have a labour relations
programme as a part of their purpose and conduct programmes to address the needs of the nurses
in their state regarding financial and job security.
Many people believe that collective bargaining is a new movement in nursing butthe fact is that nurses have been concerned with their economic and general welfare for
sometimes. In the early 1900s, working conditions and salaries for nurses were extremely poor.
Nurses working conditions were abysmal, long hours, no fringe benefit and sub-stand and wages.
Just prior to the collapse of the economy in 1929, some nurses began to recognise that protest and
collective action were necessary if the conditions of the nurses were to improve.
In 1974, the health care amendments referred to earlier made it possible for nurses
to use legal sanctions if necessary to ensure bargaining related to conditions of employment. Since
the passage of these amendments, many state nurses associations have qualified as legal
bargaining agents for nurses.
Collective bargaining looks increasingly attractive to nurses because of their
growing frustrations about the inability to practice nursing as they believe it should be practiced to
influence their working conditions or to bring about improved personal policies and benefits.
Nurses meet their in many ways. Some nurses believe that the professional organisations should
not serve as labour organisations, that this dualism represents a conflict of professional purposes
and standards.
In summary, the NLRB and federal appeals decisions have upheld the supervisory
nurses rights to belong to the professional associations. So as long as she or he does not
participate in the administration of any aspect of the organisations that assists collectivebargaining activities.
FUTURE OF COLLECTIVE BARGAINING:
The use of collective bargaining as a method for nurses to enhance their economic
and professional status holds both concerns and promises, especially with the radical changes that
are occurring in the health care industry today. The concerns are that the very process of collective
bargaining separate rather than unit nurses. Nurses in collective bargaining unit believe that
collective bargaining contracts can be vehicles to achieve their goals regarding not onlyemployment and financial issues but also improvements in practice conditions for their patients.
The future of collective bargaining for nurses, however, is unknown.
JOURNAL ABSTRACT
1) Acquiring organizational autonomy and control over nursing practice, through a
combination of traditional and non-traditional collective bargaining (CB) strategies, is emerging
as an important solution to the nursing shortage crisis. For the past 60 years, nurses have
improved their economic and general welfare by organizing through traditional CB, particularly
during periods of nursing shortages. During the past decade, however, the downsizing of nursingstaffs, systems redesign, and oppressive management practices have created such poor nursing
practice environments that improvement in wages no longer is viewed as the primary purpose of
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CB. Much more essential to nurses is assuring they have a safe practice environment free of
mandatory overtime and other work issues, and a voice in the resource allocation decisions that
affect their ability to achieve quality health outcomes for patients. The thesis presented in this
article is that traditional and non-traditional CB strategies empower nurses to find such a voice
and gain control over nursing practice. This article describes the current shortage; discusses how
CB can be used to help nurses find a voice to effect change; reviews the American Nurses
Association's (ANA's) history of collective action activities; explains differences between
traditional and non-traditional CB strategies; and presents a case study in which both strategieswere used to improve the present patient care environment.
2) In this article, the writer discusses that professionalism in the field of nursing
demands strict self-regulation and continuous improvement of the standard of care through
evidence-based recommendations and quality research. The writer notes that professionalism also
demands a multi-disciplinary approach in order to arrive at comprehensive, individualized
treatment options for the patient. The nurses' roles as researcher, planner, policy-maker, educator,
leader and collaborator testify to the ethical responsibilities they share towards patients,
colleagues and the populations they affect through their decisions. In practice, the writer maintains
that it is the nurse that plays a large part in formulating and implementing patient care plans,evaluating their outcomes and continuously enforcing and improving the quality of care. The
writer concludes that accrediting and regulatory bodies are different levels of professional
accountability in the nursing profession that protect consumers from unnecessary harm and
employers from the legal consequences of the malpractice of individual employees.
CONCLUSION
The collective bargaining has its own way between the labour and organization but still the
future of it is unknown for nursing community. collective bargaining in labour relations,
procedure whereby an employer or employers agree to discuss the conditions of work by
bargaining with representatives of the employees, usually a labour union. Its purpose may be
either a discussion of the terms and conditions of employment (wages, work hours, job safety, or
job security) or a consideration of the collective relations between both sides (the right to organize
workers, recognition of a union, or a guarantee of no reprisals against the workers if a strike has
occurred).
BIBLIOGRAPHY
Daly john, speedy Sandra, Jackson derba; professional nursing, concepts,issues and challenges S P publishers, page no.245-248.
Russell c swansburg; management for nurse managers (2nd edition) page no.159-168.
Basavanthappa B.T; nursing administration (1st edition), jaypee publication,New Delhi, page no. 312-315.
Anna marriner tomey(2004); guide to nursing management and leadership(7
thedition), mosby publications, Missouri, page no. 133-139.
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JOURNAL
o Karen W. Budd,Linda S. Warino, Mary Ellen Patton, Traditional and Non-Traditional Collective Bargaining: Strategies to Improve the Patient Care
Environment, FromOnline Journal of Issues in Nursing, published on june 2004.
o Nursing Regulatory and Accreditation Bodies; Written in 2008 Papers on "NursingRegulatory and Accreditation Bodies" and similar term paper topics.
http://www.medscape.com/viewpublication/1151http://www.medscape.com/viewpublication/1151http://www.medscape.com/viewpublication/1151 -
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PADMASHREE COLLEGE OF NURSING, BANGOLORE-72
SUB: ADVANCED NURSING PRACTICE