Working in the Healthcare Profession

1. Working in the Healthcare Profession Chapter 3

2. Healthcare Profession • The healthcare profession is unique in that it can deal with very private parts of a person’s body. • Moreover, a health practitioner might ask a patient very private and intimate questions.

3. Qualities for a Healthcare Practitioner • Technical skills: administering medications, assessing patients and their conditions, identifying instruments. operating equipment, performing medical and surgical procedures, or taking and/or reading diagnostic images. • People skills: building the self-esteem of others, showing empathy for others, communicating effectively (asking the right questions, listening effectively, and responding appropriately to emotional situations).

4. Practice of Medicine • The practice of medicine includes many more health professionals than just doctors. • We live in a litigious society, where law suits are very common option for healthcare patients. • Therefore, healthcare professionals need to practice defensive medicine as part of their patient care. • Defensive medicine means that healthcare providers must not only perform the tests and treatment that the patient requires but also the tests and treatment that will protect him or her from potential law suits.

5. Professional and Professions • A professional is one who has acquired a special skill and expertise through a formal education. • “Health care practitioner. An individual, other than a physician assistant, who is authorized to practice some component of the healing arts by a license, permit, certificate or registration issued by a Commonwealth licensing agency or board”(PA MPA 1985) • Professions are organizations made up of professionals of a specific field.

6. Professional Organizations • Professional organizations primarily do two things: (1) maintain the educational standards of the professional and (2) foster a standard of behavior through standards of care or professional codes of ethics. • For instance, the National League of Nursing NLS is responsible for accrediting colleges that offer nursing programs. • If you do not graduate from an accredited institution then you could have problems obtaining licenses later on.

7. Malpractice • Malpractice is professional negligence.

8. Standard of Care • Written requirements that stipulate what a professional healthcare worker will be held accountable for. • This is sometimes seen as the minimum care. • This is one standard that will be used in a malpractice suit to demonstrate negligence.

9. Code of Ethics • Written statements that describe the kind of behavior that a professional should strive for when performing his or her professional duties.

10. Code of Ethic for Public Health 1) Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes. 2) Public health should achieve community health in a way that respects the rights of individuals in the community. 3) Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members. 4) Public health should advocate and work for the empowerment of disfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all. 5) Public health should seek the information needed to implement effective policies and programs that protect and promote health.

11. Code of Ethic for Public Health 6) Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community's consent for their implementation. 7) Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public. 8) Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community.

12. Code of Ethic for Public Health 9) Public health programs and policies should be implemented in a manner that most enhances the physical and social environment. 10) Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others. 11) Public health institutions should ensure the professional competence of their employees. 12) Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public’s trust and the institution's effectiveness.

13. State Medical Practice Act • Article 4 of the US Constitution permits states to operate independently and write their own laws. All states have a Medical Practice Act. (See PA State medical Act of 1985) 1) Creates a Medical Board 2) Writes policies and procedures on how healthcare is delivered in the state. 3) Determines the scope of the healthcare delivery and practice.

14. Medical Board • The medical board of a state has the authority to write rules and procedures and these rules and procedures are treated as LAW.

15. Medical Boards • The Medical Boards of each state writes their own credentialing of healthcare professionals and the scope of practice. • The credentialing laws state what a person needs to accomplish (the legal requirements) to enter into a specific healthcare profession. • The scope provides the kinds of procedures and the healthcare work the professional can provide, given the specific credentials.

16. Credentialing Requirements • Each state sets its own credentialing requirements and the scope of practice. • Credentialing takes place either through state licenses or certifications. • While licenses are administered by the state, certifications are administered by accredited institutions. For instance, schools offer programs for certified medical assistants (CMA) or certified nursing assistance (CNA). • While schools determine their certification requirements they must adhere to the accrediting institutions such as The Accrediting Bureau of Health education Schools (ABHES) and the Commission on Accreditation of Allied Health Education Programs (CAAHEP)

17. Certifications and Licensing Accrediting Institutions State Medical Board Schools Licenses and Registrations Certifications

18. Healthcare Credentialing Requirements Certification Licensing • Central Service Technician • Dental Assistant • Medical Assistant • Medical Insurance Billing • Nursing Assistant • Pharmacist • Pharmacists Assistant • Phlebotomist • Physician • Surgical Technician • EMT/Paramedic, Laboratory Technician • Licensed Practical Nurse, Nurse Practitioner • Massage Therapist • Occupational and physical Therapist. • Physician Assistant • Radiology and Ultrasound Tech. • Registered Nurse • Respiratory Therapist • Social Worker

19. MPA Section 13.1. Respiratory therapists. • (a) Qualifications.--An individual shall be eligible to apply for licensure as a respiratory therapist if that individual satisfies all of the following: • (1) Submits evidence satisfactory to the board, on forms approved by the board, that the applicant has met one or more of the following criteria: • (i) Has graduated from a respiratory care program approved by the Committee on Accreditation for Respiratory Care and passed the Certified Respiratory Therapist Examination as determined by the National Board for Respiratory Care. • (ii) Holds a valid license, certificate or registration as a respiratory therapist in another state, territory or the District of Columbia which has been issued based on requirements substantially similar to those required by the Commonwealth, including having successfully passed the entry level examination. • (2) Has paid a licensure fee as established by the board by regulation. • (3) Has proved to the satisfaction of the board that the individual is of good moral character and is not unfit or unable to practice as a respiratory therapist by reason of physical or mental impairment.

20. Reciprocity • Reciprocity concerns the requirements established for the exchange of credentials from one state to another. • This only a concern if you are licensed in one state but wish to practice and be licensed in another state.

21. Scope of Practice • Each healthcare profession has a limited set of things that it can do with the particular certification or licensing. • This is usually set out by the profession’s Standard of Care. • However, the Medical Board and Practice Act has the definitive say on the scope of practice. • See The MPA of 1985 of PA for a respiratory therapist.

22. (d) Supervision and scope of practice. • -A respiratory therapist licensed by the board may implement direct respiratory care to an individual being treated by either a licensed medical doctor or a licensed doctor of osteopathic medicine upon prescription or referral by a physician, certified registered nurse practitioner or physician assistant, or under medical direction and approval consistent with standing orders or protocols of an institution or health care facility. This care may constitute indirect services such as consultation or evaluation of an individual and also includes, but is not limited to, the following services: (1) Administration of medical gases. (2) Humidity and aerosol therapy. (3) Administration of aerosolized medications. (4) Intermittent positive pressure breathing. (5) Incentive spirometry. (6) Bronchopulmonary hygiene. (7) Management and maintenance of natural airways. (8) Maintenance and insertion of artificial airways. (9) Cardiopulmonary rehabilitation. (10) Management and maintenance of mechanical ventilation. (11) Measurement of ventilatory flows, volumes and pressures. (12) Analysis of ventilatory gases and blood gases.

23. Outside the Scope • Can a healthcare professional perform technical skills as long as someone who is authorized to perform that skill supervises them? • Court Case O’Sullivan v. Mallon 390 A.2d 149, 160 NJ Super. 416 New Jersey Superior Court, Law Division (1978). P. 45

24. Employment Law • Employment law is a specialty area of the legal field. • There is not special healthcare employment law, rather employment law is applicable across the board to all industries and professions.

25. Employment law • Employment law can be divided into 3 parts: 1) Hiring Laws 2) Working Laws 3) Firing Laws

26. Hiring laws • When someone applies for a job, they should be considered for the position based only on the relevant qualifications. • The US has created certain Governmental Agencies and laws to protect against wrongful discrimination in hiring practices. • (1) Equal Employment Opportunity Commission, (2) Affirmative Action, and (3) American Disabilities Act

27. Equal Employment Opportunity Commission • The purpose of the commission is to assure discrimination based on race, religion, gender, age, disability, national origin, and pregnancy does not occur. • Not all states recognize sexual orientation as a protected class. Should they? • Affirmative Action attempts to promote diversity in the work place.

28. Affirmative Action • Affirmative Action has been criticized as a form of reverse discrimination. • If minority groups are given special treatment or their candidacy for a position is advanced despite the fact that they are not the most qualified, then this seems to commit an injustice. • What do you think?

29. Working Laws • Discrimination laws cover not only the hiring process but also while a person is working as well. • Any form of discrimination in promotions (or lack there of), harassment, etc. would apply under the non-discrimination laws.

30. Occupational Safety and Health Administration • OSHA was passed in 1971 with the purpose of protecting employees from an unsafe and hazardous environment. • Bloodborne Pathogens: describes what are bloodborne pathogens, provides a guide for precautions, how to handle exposure of these pathogens and how to dispose of medical equipment. • Material Safety Data Sheets: deals with exposure to hazardous chemicals, what the these substance, how are they harmful, how to properly handle them their risk, and what to do if exposed.

31. Workers’ Compensation • Workers Compensation protect workers who are injured on the job. • Two standard: (1) Did the employees injury/illness arise out of the work that they were asked to perform? (2) Did the employee receive the injury/illness in the course of their employment? • Limits have been placed so that the law is not abused: Workers can only get 75% of their salary up to a maximum of $1500 a month. • Healthcare providers fees for treating people on Workers’ Compensation are reduced 25%.

32. Family Medical leave Act (FMLA) • Originally (1993) the FMLA was enacted to protect women who got pregnant and had to leave temporarily their work. • Today the act includes men as well.

33. Fair Labor Standards Act • Regulates minimum wage. • Regulates how overtime is paid. • Does not regulate the number of hours of overtime and employer can give an employee.

34. Firing Laws • All companies and institutions should have a written policy stating the process of terminating an employee. • Companies and institutions are required by law to follow their written policies. • The customary process entails a verbal notice, a written notice and then termination. • Exception to following the written policy exists. When the justification for termination is something serious, such as, Intoxication or illegal drug use on the job, the use of abusive physical or verbal behavior on the job, or endangering other employees on the job, employer may terminate without following the written procedures. • Just Cause • Unions