Reimbursement Realities of Advanced Nursing Practice,” by Lindeke and Chesney, from Nursing Outlook (1999).



The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has mandated that organizations have policies in place by January 2009 for codes of conduct for employees.

Evaluate the Sentinel Event Alert article above and write a 500-750-word paper describing the policy. Include:

Sentinel Event description.

Purpose for event reporting.

What authority does The Joint Commission have to make such a mandate?

What happens to a facility that does not comply?

If you work for an organization, even it is not health care, is there a code of conduct policy in place?

Do you know about it?

Have you been oriented on the policy? If so, has anyone had to report an incident?

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located on the Student Success Center. An abstract is not required.


Behaviors and Attitudes


Most health care professionals have chosen their careers from a genuine interest in caring for others. Health care is a fulfilling, yet challenging field in which positive outcomes are not always possible when dealing with disease and illness. The entire health care system is a demanding industry from the long-standing history of hierarchical structure of professions, the increasing demand on the workforce, and the constant threat of legal retaliation from the public. Adverse work behaviors have been studied for years, as have policy decisions made to make the profession safer and more attractive for the future generation.

Workplace Behaviors

Every industry has problems with poor workplace behaviors since they all involve working with people. Human nature is described as “fundamental dispositions and traits of humans” (Britannica Concise Encyclopedia, 2006). Every industry has its own stress levels and intrinsic characteristics that can contribute to poor workplace behaviors, but the health care industry has unique situations that can increase the stress levels that can be overwhelming for any professional. Most decision or treatment options made by health care professionals have an impact on patient care or outcomes. Unlike the manufacturing industry that deals with an inanimate object, health care demands accurate results all the time.

Verbal abuse, physical threats, and violence have been ongoing issues in the health care profession for years. Many reports and research studies have attempted to make the profession and the public aware of this unsafe work environment and find ways in which to correct the situation. Recently, The National Institute for Occupational Safety and Health, a division of the Centers for Disease Control and Prevention (CDC) granted the University of Cincinnati College of Nursing an award to study violence by the public and patients against care workers in the emergency department (Koenig, 2008). Although this is not a new occurrence, the study will assess intervention effectiveness.

In 1995, 384 assaults and eight homicides occurred in hospitals. The largest number occurred in the emergency department (American College of Emergency Physicians, 2008). A recent Emergency Nurses Association (ENA) survey found that 86% of emergency room nurses were a victim of violence by patients or families of patients (Emergency Nurses Association, 2007). Often physical or verbal attacks are not reported, so accurate statistics are not possible to monitor the seriousness of the problem. Violence in the emergency department is so common that policies, instruction manuals, and entire conferences address the issue of protecting the workforce.

Assaults in the health care workplace have been accepted as just “part of the job” (Montana Nurses’ Association, 2007) and can contribute to added stress and high burn-out rates. The Massachusetts Nursing Association reports 200,000 assaults on health care workers in a 4-year span. It lists physical, emotional, cognitive, and behavioral symptoms after either witnessing an assault or being assaulted (Massachusetts Nursing Association, 2005). Reactions to the event can be so significant that the Critical Incident Stress Debriefing was developed to avoid post-traumatic stress reactions in the health care worker.

Assaults, violence, or verbal abuse can be a result of multiple reasons that impact health professionals, no matter where they are employed. Patients have long waits for care because of staff shortages or insurance coverage issues. This can cause disruptive behavior from the patient or the patient’s family. Substance abuse among emergency nurses was found to be 3.5 times higher than general practice nurses. This can be contributed to by the stress of working with trauma (, 2007). With the addition of having to deal with disruptive behaviors, many professionals seek ineffective ways to handle the stress. This issue is not isolated to the emergency department; it affects all health care professionals.

Drug or alcohol use can also affect patient outcomes and put the entire health care profession in jeopardy. The U.S. Department of Labor, Office of the Assistant Secretary reports that 5% of the hospital and other health services drink heavily and the 4% of nursing home employees drink heavily. The use of illicit drugs is even higher (U.S. Department of Labor, 2008). The positive aspect is that most organizations and the federal government have recognized the problem and have programs in place to set drug-free workplace policies. Most nursing associations have drug assistance programs to help with addiction problems.

The Institute for Safe Medication Practices (2004) lists intimidation as a form of abuse that negatively affects patient care and the possibility of forming effective collaborative work teams. The intimidation comes from other health care workers in the form of verbal abuse or threatening body language. Those that feel intimidated hesitate to question an order or action taken by others, often at the expense of patient care. Male and female employees felt equally intimidated by behaviors from all health care professionals. Few reported their issues even though their organization had a written policy to deal with the problem (Institute for Safe Medication Practices, 2004).

Policy Change

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has as its mission to improve the safety and quality of care by health care faculties. It performs inspections and gives accreditations to those facilities that pass the inspection. It also seeks to improve the quality of care delivered to the public by decreasing adverse events, known as sentinel events (JCAHO, 2008a). One of the ways in which sentinel events can be decreased is to change destructive behaviors that are present in the health care facilities. Effective January 1, 2009 all accreditation programs must have added code of conduct standards that address disruptive and inappropriate behaviors. JCAHO researched and presented conferences to find answers and solutions to this destructive behavior prevalent in the health care industry for years.

One of the mandates from JCAHO is that an organization has a written policy that identifies disruptive behavior, a consistent reporting and enforcing policy, and an education program to inform all employees that certain behaviors are not acceptable, no matter what position one holds (JCAHO, 2008b).

The National Institute for Occupational Safety and Health (NIOSH), a CDC research agency in the U.S. Department of Health and Human Services, works with hospitals to educate health care professionals on violence in the workplace and the organization on the importance of developing written safety policies to address violence. They have written and other formats of media publications available for assistance (The National Institute for Occupational Safety and Health, 2002).

Occupational Safety and Health Administration (OSHA, 2007), through the U.S. Department of Labor, also works with health care facilities to improve the safety of employees and decrease the incidence of violence toward the workforce. No specific laws are enforced regarding mandating organizations to write formal policies on workplace violence, but multiple governmental and private organizations have made strong recommendations to do so.

Improving Patient Care

Decreasing workplace violence, abuse, intimidation, or physical threat was identified as a way to improve patient care by improving collaborative practice patterns (JCAHO, 2008b). Making a safer work environment allows health care professionals to focus on patient care issues. Deborah Gardner (2005) lists the 10 points of collaboration as a way first to know one’s self, to then know how to handle diversity, and then be able to manage collaboration through a true team effort. Collaboration focuses on patient care issues and not personnel issues. It brings together equal, expert opinions that can decrease errors and increase mutual respect.

Increased specialization within the health care industry makes it more necessary than ever to practice collaboration in the health care system. Educational systems and employer groups must teach new professionals the importance and the practice of collaboration (Lecca, Valentine, & Lyons, 2003). The Transdisciplinary Collaboration Approach brings in all the specialties involved in the care of patients to form the integrated patient care approach for better patient care (Lecca et al., 2003, p. 252).

Different specialties, individuals, or professions may tend to limit input into patient care in an effort to hold the power of authority in patient care issues. This can only have a negative effect on the overall wellbeing of the patient. The American Organization of NurseExecutives (2007) set the 2007 Guiding Principles for Relationships among Nursing and Support Services in Clinical Settings as a mandate for nursing collaboration with all other departments for positive patient outcomes. All health care specialties must agree with these opinions to facilitate a change to a culture of safety.


Working conditions in the health care industry need to change to a more positive, less threatening environment. These changes must come both from health care workers who have been victims of disruptive behaviors and those who exhibit disruptive behaviors. Health care facilities need to enforce a no-tolerance policy for such behaviors and administer them in a fair and consistent manner.

1. Critical Challenges: Revitalizing the Health Profession for the Twenty-First Century

Read “Critical Challenges: Revitalizing the Health Profession for the Twenty- First Century,” located on the Center for the Health Professions at the University of California, San Francisco website.

2. Health and Wellness: The Shift from Managing Illness to Promoting Health

Read “Health and Wellness: The Shift from Managing Illness to Promoting Health” by Draper, Tynan, and Christianson, from HSC Issue Brief No. 121 (2008) located on the Center for Studying Health System Change website.

3. The Effect of Health Care Cost Growth on the U.S. Economy

Read “The Effect of Health Care Cost Growth on the U.S. Economy Final Report,” by Sood, Ghosh, and Escarse (2007), located on the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (HHS) website.

4. U.S. Health Care Spending: Quick Reference Guide

Read “U.S. Health Care Spending: Quick Reference Guide,” located on the California HealthCare Foundation website.

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