Beardwood Barbara A, Kainer Jan M
York University, Toronto, ON, Canada.
Nurs Inq. 2015 Mar;22(1):50-63. doi: 10.1111/nin.12048. Epub 2013 Aug 29.
This article explores risk in professional nursing practice. Professional risk refers to the threat of professional discipline if it is found that a registered nurse has violated professional nursing practice standards. We argue professional risk is socially constructed and understood differently by nurse regulatory bodies, unions, professional associations and frontline nurses. Regulatory bodies emphasize professional accountability of nurses; professional associations focus on system problems in health-care; unions undertake protecting nurses' right to health and safety; and frontline nurses experience fear and uncertainty in their attempt to interpret practice standards to avoid professional discipline. Perspectives of professional risk are investigated by analyzing three professional nursing bodies' views of professional codes governing the right of nurses to refuse unsafe work assignments. The workplace dynamics surrounding work refusal experienced by frontline nurses are illustrated primarily through the lens of the 2003 SARS influenza outbreak in Ontario, Canada. We conclude that frontline nurses in Ontario are required to manage risk by following professional protocols prioritizing patient care and professional accountability which disregard the systemic, unpredictable and hazardous circumstances in their everyday practice. Moreover, we argue professional protocols cannot anticipate every eventuality in clinical practice creating the fear of professional discipline for nurses.
本文探讨了专业护理实践中的风险。职业风险是指，如果发现注册护士违反了专业护理实践标准，可能面临专业纪律处分的威胁。我们认为，职业风险是社会建构的，护士监管机构、工会、专业协会和一线护士对此的理解各不相同。监管机构强调护士的职业责任；专业协会关注医疗保健中的系统问题；工会致力于保护护士的健康和安全权利；而一线护士在试图解读实践标准以避免受到专业纪律处分时，会感到恐惧和不确定。通过分析三个专业护理机构对规范护士拒绝不安全工作任务权利的专业守则的看法，来研究职业风险的观点。一线护士经历的围绕工作拒绝的职场动态，主要通过2003年加拿大安大略省严重急性呼吸系统综合症（SARS）流感疫情这一视角进行阐述。我们得出结论，安大略省的一线护士需要通过遵循优先考虑患者护理和职业责任的专业规程来管理风险，而这些规程忽视了他们日常实践中存在的系统性、不可预测性和危险性情况。此外，我们认为专业规程无法预见临床实践中的每一种可能情况，这让护士们担心会受到专业纪律处分。
