1) Please give feedback to the summary below.

2) What would be another managerial action and compliance tool not mentioned?

3) What is another way to not be negligent with the law?

Critical Analysis of the Law

Fair Labor Standards Act (FLSA)

The Wage and Hour Division (WHD) of the U.S. Department of Labor (DOL)enforce the Fair Labor Standards Act (FLSA), which establishes wages, overtime, recordkeeping, and child labor laws (U.S. Department of Labor, n.d.a).The law created two employee classifications of exempt and non-exempt. Exempt workers are paid a predetermined and consistent salary every pay period, regardless of the actual amount of hours worked. Employees in these positions are not required to track time worked, since their paid salary amount is the same each pay period, regardless of their hours worked. Non-exempt workers are paid based on actual hours worked. Employees in these positions are required to report all time worked and be paid overtime (1 times their regular rate of pay or better) for time worked beyond 40 hours in a standard 7-day workweek.

29 U.S.C. 201 and following of FLSA, an employer can require overtime or fire their employees for refusing to work overtime (U.S. Department of Labor, n.d.b). There are no set limits on how many hours a day or hours a week the employer can require an employee to work, but the recordkeeping must show an employment contract that dictates pay rates and expectations for overtime (U.S. Department of Labor, n.d.b).

Noncompliance

Criminal penalties, that include civil money penalties and imprisonment for each violation, can be assessed to employers who willfully violate the law (U.S. Department of Labor, n.d.a).Under

Responsibilities

All non-Exempt employees are required to maintain and submit accurate records of their hours worked for manager review and approval. Employers are required to post an official poster that outlines the provisions for FLSA and any updates. Ideally, non-exempt employees obtain the approval of their supervisor prior to working overtime Even in situations where an employee does not obtain advance approval, they must be paid for all hours worked. Working overtime without supervisory approval may result in disciplinary action because of budget implications and possible financial harm to the organization. Also, excessive overtime can cause worker exhaustion, lower productivity, and more dangerous work conditions. It is the managers' responsibility to supervise their workers and manage hours worked.

Employers have an obligation to ensure that all non-exempt employees are paid appropriately for all hours worked, including overtime pay for hours worked beyond 40 in a workweek. Supervisors and Managers of non-exempt employees are the most important link to meeting this critical Federal Regulatory requirement. Managers who fail to ensure that non-exempt employees are paid for overtime hours worked are violating a Federal Law and are placing themselves and the organization in serious compliance jeopardy.

Nurses

Nurses do not fall within the list of professions what are exempt from overtime pay and as nonexempt employees must receive overtime pay for hours over the 40-hour work week (U.S. Department of Labor, n.d.b). Nurses who were forced to work overtime have a 2-year statute of limitations to recover back wages and liquidates damages and 3 years for willful violations of FLSA by their employer (U.S. Department of Labor, n.d.a).

Employee Evaluation Checklist

Pros

A supervisor's Evaluation Checklist of Employees can be a strong communication tool if used appropriately and effectively. Using a rating system such as the one proposed by Staff Report (2001), ensures that all employees are rated on the same scale and can be tailored to goals that are based on a profession. A scale system also avoids exaggerated statements and inflammatory language that result in misunderstandings. Because everyone gets evaluated according to the same scale, the criteria avoid discrimination and force managers to think critically about employee performance. Checklists also employee behaviors into skill-related sections that encourage managers to show employees what traits are important to the manager.

Cons

When an employee performance review is one-sided, such as when an employee receives several marks in the "needs improvement" category, the employee may conclude that the dialogue is not realistic and stops listening because he/she disagrees with the review. When a manager has a bias toward an employee it can be beneficial or damaging to the review. If the manager unconsciously favors an employee, the manager may give a better review than was deserved. Employees grow complacent between reviews when they think the managers are not tracking performance. Another con of employee evaluation checklists are that they can be time consuming when managers have to explain their ratings.

My Best Practices

Some of the best practices I have used as a manager include providing feedback regularly instead of just annually or semi-annually. This allows me to immediately give kudos when employees are performing well and cored performance that needs to improve. I document these comments and dates on the evaluation forms that I will have to use for the annual review so that I am not spending longer amounts of time focusing on remembering what people did well or needed to improve on during the year. I can also track their progress to show how they have improved on something I needed them to change.

While I will often include words that I know are on the evaluation to help them better connect to the review annually, I also try to capture specific things that give employees specific feedback to them and not just vague statements. For example, "Thank you for showing that family member the kind of care that I would want for my family" instead of "Thank you for doing a good job." Acknowledging and recognizing employees put them front and center and makes them feel valued.

Strategic Compliance with the Law

Legal Risks at Metropolitan Community Hospital (MCH)

Metropolitan Community Hospital (MCH) is at risk for being accused of medical malpractice, negligence, liable workplace harassment, and noncompliance for poor patient quality and safety. The failure of leadership to address managerial responsibilities that adhere to the MCH's mission has led to the dysfunctionality among leadership, clinicians of all levels, and work environments. The nursing staff had ethical responsibilities to the employees to create ethical culture that addresses concerns, promotes a health work environment, is inclusive, and uses employee's knowledge and skills effectively (Perry, 2020). According to Alam (2016), "Predominantly the underlying causes of medical errors are; communication problems, inadequate information flow, human related problems, organizational transfer of knowledge, staffing patterns and work flow, inadequate policies and procedures and technical failures" (p.1).

Staff Negligence & Liability

Inadequate patient to direct care giver ratios not only contributed to a negative perception of MCH, but also increased the likelihood of medical errors and accidents. According to the Agency for Healthcare Research and Quality (2012), "state-mandate nurse staffing levels alleviate workloads leading to lower patient mortality and higher nurse satisfaction" (Perry, 2020). The threat to patient safety increases that risk of malpractice litigation. This negative work and care environment is likely to result in legal, political, and public relations damage for MCH. MCH's patient could perceive that they were not getting the clinical care they needed because the nurses were caring for 12 patients each. With the nurses stretched so thin, they may feel the need to cut corners or take risks such as leaving patients unattended or delay care services. Also, the nurses may not be able to take required breaks because they are too busy caring for the patients and addressing families, thereby increasing burnout, fatigue, and anxiety that may care additional errors. MCH could face litigation for negligence under the doctrine of corporate liability if an employee were to breach their duty (Showalter, 2020).

Management Compliance Tool

I would use an Enterprise Risk Management (ERM) framework tool to identify, manage, and mitigate risks across the organization. By focusing on the right risk domains of operational, clinical/patient safety, strategic, financial, human capital, legal/regulatory, technology and hazards to maximize value protection and support decision-making that aligns the best business practices (NEJM Catalyst, 2018). The ERM framework can serve to build departmental cohesiveness, prioritize risks, determine allocation of resources, estimate potential consequences, and develop a response and containment plans (NEJM Catalyst, 2018).

Process for Prevention

The process I would use to prevent nursing shortage risks would be to create frontline and nurse leadership governance team to work with risk managers, patients, and payers. Together they would accomplish a multistep system to create limited-risk healthcare environment. First, I would ask the nurses what threats they perceive in the care areas, in the collaboration of staff, and the leadership approached. Second, I would have them develop a risk matrix based on the likelihood and impact of occurrence of each risk. Third, they would develop a plan for a meaningful and actionable plan to correct errors or near misses. Fourth, I would develop a policy for the compliant reporting to oversight bodies. Fifth, I would use a program like Midas or Voice to capture and learn form risks and potential risks, where employees are encouraged to report risky situations. Sixth, I would have "mystery shoppers" look for latent failures and encourage the risk managers and the governance team to do root cause analysis to uncover causes of the risky behaviors. Seventh, I would use a robust Risk Management Information System (RMIS) to improve performance and make data comparisons to determine how to properly manage funding for transferring risk. This is process is important in identifying and tackling key components of on-going risk management in the healthcare setting (NEJM Catalyst, 2018).

According to NEJM Catalyst (2018), risk management plans (RMPs) also include seven fundamental components that would increase the prevention of risky behaviors and errors. First, education and training of employees should happen during orientation and be carries our regularly throughout employment. Second, responding to patient and family grievances should be included in the RMP to dictate response times, staff responsibilities, communication needs, and actions to be taken. Third, "specific goals to reduce liability claims, sentinel events, near misses, and the overall cost of the organization's risk should also be well-articulated" (NEJM Catalyst, 2018, para. 13). Fourth, leadership and staff need to communicate reporting requirements, risky activities and RMPs in an open and collaborative manner. Fifth, the hospital needs a contingency plan for emergency situations. Sixth, a reporting system that identifies and tracks everything from possible risks to mandatory reporting will help everyone across the hospital communicate more effectively when incidents occur. Finally, appropriate responses to risks and events that mitigate future failures should be used to prevent healthcare risks.

Nursing Retention

Nursing retention is vital to maintain the quality of care expected by a reasonable person. Unfortunately, MCH faced a quality verses cost savings scenario when then forced nurses to work overtime, increased nurse-patient ratios, failed to immediately address nurse turnover trends (Showalter, 2020).

Management Compliance Tool

I would use a workforce management software (WMS) as a compliance tool to retain and attract staff. WMS improves the work environment by optimizing scheduling based on employee preferences, patient census, and surgical-to-inpatient flows. When employees have greater control over their working lives, they feel empowered. The WMS would encourage safe staffing based on patient acuity and distribute workloads appropriately. This creates a system of fairness and uses algorithms to determine levels of care necessary. By rotating the staff throughout departments and floating them to areas they are not comfortable working in, MCH was not valuing the employees or using them to the full extent of their knowledge and skills. The WMS could automate the profess and guarantee that favoritism would not exist when it comes to workloads.

Nursing Process for Retention

Evidence-based mechanisms for addressing nursing shortages need to be used to salvage the relationships between the current MCH employees and develop new professionals to feed into the system.

I would start with high schoolers. When nursing shortages hit my organization hard and the staff to patient ratios looked like they would suffer, I got creative in solving community and organizational issues. The hospital was in great need of Certified Nursing Assistants (CNAs) and the county's high school program to certify CNA students was struggling to find clinical placements for students. I used my pull as the President of the Healthcare Profession Program Advisory Committee to negotiate new placements for the students within my organization's 2 hospitals. This gave the students the 40 hours of clinical bedside time while supporting our staff in carrying out the system's mission. I was able to increase awareness of nursing as a career option to the high school students, increase the time they were able to spend working alongside CNAs and nurses in the hospital, and further the health career training programs in the county.

I would also address the financial demands by highlighting financing options for nurse training that often deter people from entering the healthcare profession. By providing financing options, tuition reimbursement, training programs for moving from one certification/license to another, and making education more accessible, I would enhance the educational resources and create more student nurses that could filter into becoming nurses at the organization.

I would also lobby for maximized licensure reciprocity and alternative licensing requirements. This could expedite hiring new nurses and encourage nurses to relocate from other areas where there are not nursing shortages. Opening opportunities for international nurses to undergo skill assessments and encourage all employees to alleviate barriers through a diversity and inclusion program will help support the professional development on a multicultural scale.

Mitigating a Negligence Lawsuit

To lower the chances of a negligence lawsuit, I would focus on hiring recruiters and talent development specialist to form a Human Resources team that would focus on nurse recruitment and retention. This Human Resources team would be responsible for making sure that nurse managers learn and use the WMS to make the current staffing more enjoyable and fairer. They would also be responsible for recruiting people from the community and outside the community to tap into the market of new employees. It must be made very clear that salaries/wages for all similar clinicians will be even, despite where the clinician was trained. Finally, this team would work developing a more cohesive and collaborative team among those inside the organization already. They would host trainings for the medical staff on effective communication techniques for engaging with nurses and empower the nurses to speak up or report issues with the medical staff. By getting the medical staff and the nurses to work together to provide a healing presence within MCH, this will lower the volume or negligence cases and reinforce appropriate conduct among the professionals at MCH (Perry, 2020). Interventions and corrective action would be executed for failure to comply with the MCH Code of Ethics and expectations set for colleague engagements with one another.

The most important part of this process is notifying all stakeholders of the actions carried out by this Human Resources team. Making the stakeholders aware of how MCH is handling the situations as they evolve will improve transparency and confirm that MCH is taking actions to improve their processes.

References

Alam,A.Y. (2016). Steps in the process of risk management in health care.Journal of Epidemiology and Preventive Medicine, 1-5.DOI: 10.19104/jepm.2016.118

NEJM Catalyst. (2018, April 25).What is risk management in healthcare?Catalyst.NEJM.org.https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197

Perry, F. (2020).The tracks we leave: Ethics and management dilemmas in healthcare. (3rd ed.).ACHE Management Series.

Showalter, S. (2020).The law of healthcare administration. (9th ed.).Health Administration Press.

Staff Report. (2001, March 23).Employee evaluation checklist. Workforce.com.https://workforce.com/news/employee-evaluation-checklist

U.S. Department of Labor. (n.d.a).Handy reference guide to the Fair Labor Standards Act.https://www.dol.gov/agencies/whd/compliance-assistance/handy-reference-guide-flsa

U.S. Department of Labor. (n.d.b).What are the minimum wage, overtime pay, and recordkeeping requirements?https://www.dol.gov/agencies/whd/direct-care/requirements