Professional Issues Study Guide for the CEN

General Information

In the practice of emergency nursing, professional guidelines must be followed whenever possible. Questions about these topics account for about nine percent of the Certified Emergency Nurse (CEN) exam. There will be questions concerning legal issues as well as general professional practices.

Nurse

The nurse must be aware of their professional, legal, and ethical responsibilities to the patient at all times. The nurse must also be aware of any preexisting biases they may hold and work to address and overcome them. They should incorporate evidence-based practice into the care that they provide to patients and commit to lifelong learning. It is essential to learn effective stress-management techniques as well as techniques for avoiding workplace violence and coping with it if it does occur. As a nurse, you will also rely on employer support. Working with the entire healthcare team to optimize working conditions, ensure adequate break coverage, and provide safe staffing ratios will ensure the patient receives the best possible care.

Ethical Dilemmas

Ethical dilemmas occur when the patient or their designated power of attorney for health care (DPOA-HC) must make a difficult choice between two conflicting courses of action, both of which are morally ambiguous. For example, the patient’s DPOA-HC may be placed in a situation where they must decide whether to prolong life support after the patient has experienced a massive stroke with no chance of recovery. Many hospitals maintain special ethics committees to review these situations, offer guidance to all involved, and help to determine which action is best for the patient. The committees are usually composed of doctors and nurses who work directly with patients as well as case managers from across the hospital.

Evidence-Based Practice

Evidence-based practice is providing patient care that is driven by the latest research-based evidence combined with clinical experience. The research should be derived from peer-reviewed studies or articles in reputable scientific journals. Every healthcare worker should use evidence-based practice to guide their care. Evidence-based care drives interventions that range from childhood vaccinations to surgical techniques. This care also needs to consider the patient’s individual circumstances.

Lifelong Learning

Lifelong learning is the healthcare worker’s commitment to continuing their education as long as they hold their license. Many states require that nurses complete a certain number of hours of continuing education, also known as continuing education units (CEUs), prior to license renewal. Sometimes these units will be on specific topics such as pain management, human trafficking, and implicit bias. Because best practices change over time as research evolves, it is crucial to pursue lifelong learning to provide the best possible patient care.

Impaired Nurse and Drug Diversion

According to the American Nurses Association, the rate of chemical dependency and associated impairment among nurses is 10 to 15 percent, meaning they have substance use issues that range from misuse to an officially diagnosed substance use disorder. Impaired nurses are at an incredibly high risk of injuring themselves or the patient due to poor clinical judgement. Impaired nurses are also far more likely to divert drugs, or transfer them from their prescribed patient, than a sober colleague.

If a nurse is found to be impaired, there are a number of treatment programs and requirements put forth by the state board of nursing that they must meet to retain their license. Depending on the nature of the diversion, the nurse may work on a restricted license, meaning they will not be able to administer certain medications (e.g., narcotics) or might be required to have another nurse witness the administration.

Workplace Violence

Workplace violence occurs when a healthcare worker is injured by a patient, family member, or another coworker. The term encompasses verbal abuse, threats, physical assaults and injuries, and even homicides. Unfortunately, workplace violence is becoming increasingly common. According to the American Hospital Association, over 80 percent of healthcare workers have experienced verbal violence, and up to one-third have experienced physical violence. It is the employer’s duty to protect employees from workplace violence and offer physical, emotional, and financial support to patients who are injured on the job.

Stress Management

Because healthcare workers, especially bedside nurses, face an overwhelming amount of physical, emotional, and mental stress at work, stress management is critical. Burnout occurs when the nurse becomes physically and mentally exhausted due to prolonged or excessive stress. Compassion fatigue occurs when the nurse goes through the motions of their job without being emotionally present, detaching from the work to protect themselves.

The employer should provide education on stress management techniques, help create a healthy working environment, and minimize the use of mandatory overtime shifts. Debriefing after stressful situations, such as a rapid response or code blue, helps the nurse to process what has occurred. Counseling should be offered through a free and anonymous employee assistance program (EAP) in which the employer is not privy to anything discussed. Outside of work, lifestyle changes can help in the management of stress. Examples of such changes include spending more time with family and friends, exercising, spending time outside, practicing yoga or meditation, and focusing on other preferred hobbies.

Just Culture

The nurse should work in a just culture where mistakes or concerns about another worker can be reported promptly without fear of reprisal. The focus is on identifying the system processes that enable a sentinel event. A sentinel event is a serious unexpected occurrence that affects patient health and safety in a negative way, such as a medication or surgical error. It is essential to recognize each individual’s role in the error. Once these processes have been identified, appropriate changes should be implemented to reduce the risk of the error recurring. A healthcare facility should have a designated system for tracking sentinel events and near misses and should keep employees updated throughout the process.