Professional Nursing Roles and Values

1 Professional Nursing Roles and Values 03/9/21 2 A. Nursing Theory The nursing theory that has influenced my values and nursing career is the self-care deficit model by Dorothea Orem. Her theory focuses on nursing intervention that helps the client cope with unmet care needs by acquiring the maximal level of function (Contemporary Nursing, 2018, p.78). With this model, it aims to help patients meet their needs. This was a theory I used when I worked as a nurse at a school for children with special needs. Many of them had developmental and intellectual disabilities. Despite their limitations, I worked with them by setting goals that would allow them to progressively achieve and meet those needs as it applied to their activities of daily living such as eating, toileting, and mobility. A1. Excellent Nursing Practice The object of Orem’s theory is to restore the client’s self-care capability to enable him or her to sustain structural reliability, performance, and growth through purposeful nursing intervention. (Cherry & Jacob, 2018, p.78). Nurses can apply the self-care theory by providing care that guides and supports the patient in caring for themselves. There are patients may have lost some function such as feeding, bathing, or clothing themselves which can discourage patient and affect their quality of life. Nurses can assess the needs the patient has in these areas of selfcare and them formulate a plan to work on these needs. For example, if a patient has lost their ability to feed themselves due to suffering a stroke and losing some function in their dominant arm, the nurse can implement a plan for the patient to practice holding or picking up utensils. Working with a patient on their needs gives them an opportunity to increase their quality of life by gaining independence and autonomy in their self-care. 3 A2. Professional Nursing Practice Theory When I worked at a school for kids with special needs, many of them had developmental and intellectual disabilities along with other health issues. I worked with the students by setting goals that would allow them to progressively achieve and meet those needs as it applied to their activities of daily living such as eating, toileting, mobility, etc. Some kids required use of assistive devices such as a wheelchair, walker, and hoyer lift. I had a student who had cerebral palsy, was in a wheelchair, and required a hoyer lift during transitioning with toileting. One way I utilized the self-care model was by giving the student an opportunity to be involved in her care during toileting. The student would assist by holding the remote and press the button for the hoyer lift to go up or down. Doing this gave the student joy in knowing that she was helping in her care. B. Historical Nursing Figures A historical nursing figure that comes to mind is Florence Nightingale. I first heard about Florence Nightingale when I started nursing school back in 2010. She was considered as the pioneer of nursing who paved the way for future nurses and known for her efforts to better practices in cleaning and sanitation to prevent the spread of diseases. She was also known for her contributions in taking care of sick and injured soldiers during the war. Another figure who contributed to nursing is Jean Watson who was known for her theory of human caring which many nurses utilize today. Jean Watson had a holistic view on patient care that focused on altruism, sensitivity, trust, and interpersonal skills (Cherry & Jacob, 2018, p.78). B1. Difference in Contribution Florence Nightingale and Jean Watson have made a big impact in the world of nursing though they had some differences within their contributions. Florence Nightingale focused on 4 the environment in which patient care was given. Florence Nightingale noted that “Nursing is putting us in the best possible conditions for nature to preserve health—to prevent, restore, or cure disease or injury.” (Cherry & Jacob, 2018, p.78). She believed that a patient was able to heal and recover better in certain conditions such as good ventilation, reducing noise, a healthy diet, adequate lighting, and cleanliness. On the other hand, Jean Watson was concerned about the caring attitude displayed towards patients. She believed that the act of caring would bring physical healing as well as emotionally. Her theory of human caring brought forth the presumption that “the client will experience balance and harmony in mind, body, and soul. Harmony, or wellness, will prevail, whereas disharmony, or illness, will be altered, eliminated, or circumvented”. (Cherry & Jacob, 2018, p.78). B2. Description of Historical Figures The contributions of both Florence Nightingale and Jean Watson have made an impact throughout my nursing career. My first nursing job was as a hospice field nurse. In the field, I made visits to my patient’s homes and also nursing facilities. One of my duties was to assess the home environment of my patients and to make sure it was safe and kept clean. When performing procedures or giving medications, it was also important for me to implement clean techniques and utilize proper hand hygiene. The practices Florence Nightingale implemented as a nurse definitely influenced the skills that I was taught in nursing school and have now continued to utilize in my nursing career. What she has contributed to nursing will continue to motivate me provide the best environment possible for my patients. Jean Watson inspires me to continue to strive to be a better nurse. I became a nurse because I had a passion to help people and I believe if you want to help others then you must also care for them. Her theory of human caring 5 motivates me to not only see a patient and their illness, but to see them in a holistic sense while caring for their physical well-being but also their emotional and mental health. C. State Board of Nursing VS. American Nurses Association (ANA) Each state has their own board of nursing that regulates nursing practice in regard to licensing and safety. On the other hand, the American Nurses Association (ANA) is “the premier organization representing the interests of the nation's 4 million registered nurses” (American Nurses Association, n.d.). C1. Roles of Organization The board of nursing is also responsible for “the review of a nurse’s potential malfeasance or violation of the act or other state or federal laws (Cherry & Jacob, 2018). Each state board of nursing institutes and enforces laws and ensures that nurses are practicing within their scope of practice they are licensed for in accordance with state and federal laws. The state board of nursing also implements disciplinary action for any violations. The ANA supports nurses by advocating for nurses’ rights and standards in nursing practice. A main focus of the ANA is to “advance the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public” (American Nurses Association, n.d.). C2. Influences of the State Board of Nursing and ANA Both of these organizations are an important part in my nursing practice. The state board of nursing makes sure my license is current and that continuing education is completed for license renewal. The state board also gives an outline regarding my scope of practice as a registered nurse. The ANA on the other hand is a resource that is available to me for support. 6 The ANA provides a community that empowers and advocates for nurses to continue to lead the future of health care. C3. Requirements for License Renewal in State I am licensed in the state of California. I am required to renew my license every two years. The board of registered nursing sends me a notice in the mail regarding when my renewal is due. The board also notes that “All RNs in the State of California who wish to maintain an active license are required to complete 30 contact hours of continuing education for license renewal” (California Board of Registered Nursing, n.d.). The renewal application fee is $190.00. C3a. Consequences of Failure to Maintain License Requirements There are three license statuses: Active, Inactive, and Delinquent. According to the California board of registered nursing (n.d.), if the renewal requirements are not completed, the renewal will be delayed. If the payment is made but the 30 hours of continuing education is not done, the license will no longer be active but become inactive and I would not be able to practice as a registered nurse. My license status would become delinquent if I chose to let my license expire. However, if I wanted to return to nursing and it had been less than 8 years since my license expired, I would be required to submit a delinquent renewal fee and completion of 30 hours of continuing education within the past two years. (California Board of Registered Nursing, n.d.). Furthermore, if my license was expired for more than 8 years, I would still need to “submit the delinquent renewal fee, 30 hours of continuing education, and proof of competency to practice by either verification of a current active license in another state or U.S. territory, or by retaking the licensing exam” (California Board of Registered Nursing, n.d.). 7 C4. Requirements for Compact and Non-Compact State According to the National Council of State Boards of Nursing (NCSBN), California has pending legislation for Nurse Licensure Compact. Having a license in a compact state allows you to also work as a nurse in another compact state. However, if you are licensed in a noncompact state and wish to work in a compact state, you must “Apply for licensure by endorsement to the board of nursing in the state where you seek a license” (National Council of State Boards of Nursing, n.d.). D. Food and Drug Administration and the Center for Medicare and Medicaid Services The Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS) are two U.S. government agencies that are part of the Department of Health and Human Services. Though these two agencies are part of the same department, they each govern different areas of health care. The FDA oversees certain foods, medications, and medical devices are safe to use by the public while the CMS provides health services such as health care insurance through its various programs. The products that the FDA is responsible for include human and veterinary drugs, vaccines, tobacco products, dietary supplements, cosmetics, electronics, and food except for meat from livestock, poultry, and some eggs products. The FDA ensure these products are sanitary and also properly labeled (U.S. Food & Drug Administration, n.d.). The CMS works to provide access to high quality care and improved health at lower costs (USA Gov, n.d.). D1. FDA and CMS influence on my Professional Nursing Practice The FDA has influenced my nursing practice by safeguarding the medications I give to my patients. With their oversight, I have the confidence that what I am administering to my patients have been tested to be safe for their use. The CMS gives me resources in educating my 8 patients regarding what health care services are available so that they can choose the best option suitable for their health care needs. D1a. Role as Patient Advocate in Promoting Safety in Alternative Therapy An important duty of being a nurse is to be an advocate for those in your care. Patients have a right to make choices for their personal health. As a nurse, I must be an advocate for my patients’ rights while also educating them regarding their health. If a patient was to request to use alternative therapy other than what has been prescribed by their doctor, I would advocate for them by listening to their concerns and questions. I would do my best to give them factual, unbiased information regarding medical treatments and discuss possible benefits and risks to alternative therapy. By doing this, I give my patients an opportunity to make an educated decision regarding their health. E. Discuss the purposes of the Nurse Practice Act in your state and its impact on your professional practice. According of the California Board of Registered Nursing, “The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs” (California Board of Registered Nursing, n.d.). California nurses must follow the laws set forth in the nurse practice act with gives guidance regarding scope of practice to ensure quality and safe care is given to patients. It also lists the duties as well as limitations of nurses working in California. The California Nurse Practice Act impacts my profession by providing me rules to follow as I work as a nurse which protects me as well as the patients in my care. These laws give me guidance for nurse responsibilities which includes license requirements, medication administration, training requirements, and standards of care. Without these laws, there would be a lack of accountability and oversight in the care I provide which can 9 be harmful to myself and to patients. The regulations set forth ensure that I am competent and working within the scope of my license. 1. Scope of practice for a RN in my state. The scope of practice for RN’s in California include “basic health care, which help people cope with difficulties in daily living which are associated with their actual or potential health or illness problems, or the treatment thereof, which require a substantial amount of scientific knowledge or technical skill” (California Board of Registered Nursing, n.d.). Nursing practice has three areas of function: independent functions, dependent functions, and interdependent functions. Independent functions include providing basic care needs such as comfort, safety, hygiene, the performance of skin tests, administration of immunizations, and blood withdrawal. Independent functions also include observing signs and symptoms of disease, medication and treatment reaction, and behavior and physical condition that may warrant emergency procedures. Dependent functions include administration of medications and agents ordered by licensed physicians, dentists, podiatrists, or clinical psychologists. Lastly, interdependent functions include implementation of standardized procedures or changes in treatment regimen (California Board of Registered Nursing, n.d.). 2. Discuss how your state defines delegation for the RN. The Standards of Competence Performance found in the California Code of Regulations states that the registered nurse “delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the task to be delegated” (California Board of Registered Nursing, n.d.). The RN must also supervise the care being given. It is also noted that when an RN delegates to an LVN, the RN must make sure that the LVN had been properly trained with the skills needed to perform the task and this is done by 10 ensuring their competence is documented. (California Board of Registered Nursing, n.d.). In delegating task, the RN is to use the “Five Rights of Delegation” which includes the following: right task, right circumstance, right person, right direction/communication, and right supervision provided. In the event that a task is not being done correctly, the RN must also intervene. In supervising the LVN, the RNs role is to give clear directions and monitor performance for compliance with standards care practices, policies, and procedures (California Board of Registered Nursing, n.d.). F. Nursing Roles In WGU’s BSN Nursing Program Conceptual Model, the nurse as a scientist is defined as one who “participates in scientific inquiry to inform healthcare decisions; and critiques, disseminates and implements evidence to influence practice” (Hometzl, 2021). In my professional practice, I apply this role of scientist in different ways. As a nurse, I have a duty to explain to patients regarding their disease process, symptoms, as well as treatments and medications. I also participate in collecting data and utilizing my findings into the care I give. The nurse as a detective is defined as one who “uses clinical imagination coupled with nursing science to detect subtle changes and deviations from expected patterns of being to prevent or control adverse outcomes” (Hometzl, 2021). This role is applied during patient assessments. As a detective, I need to ask the patient questions in regard to how they are feeling and assess for any abnormalities. In my experience, there have been times when I would ask a patient if they are in any pain and they would reply by saying no. However, when I palpate a certain area of their body, I would notice wincing or grimacing. With this observation, I can see that the patient is experience some pain or discomfort and from their further assess their 11 condition. In this role, monitoring and watching for any changes in condition is important so that I am able to intervene when necessary. The third role noted in the model is the nurse as a manager of the healing environment. This role is defined as “The healing environment is global in nature and includes considerations of healthcare policy, finance and regulations. Acknowledging this, the nurse creates, coordinates, and advocates for a respectful, interdisciplinary environment that promotes optimal well-being and affirms the dignity of the human experience” (Hometzl, 2021). Nurses are at the forefront of health care. Therefore, we have a duty to set an example to others. In my workplace, I utilize this role by having a positive attitude and encouraging my co-workers. Nursing can be a stressful job and can oftentimes cause burn out and even competition with one another. Because of this, it is important for me to apply this role on a daily basis. By respecting my supervisors, peers, and patients, trusting relationships are formed which creates a positive working environment. G. Two provisions from the American Nurses Association (ANA) Code of Ethics In the ANA Code of ethics, provision two states, “The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population” (American Nurses Association, 2015). Provision three states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” (American Nurses Association, 2015). 1. Influence of the two provisions on my professional nursing practice. Provision two influences me as a nurse because I am responsible for providing the best care to patients and their families. As a nurse, I recognize that the patients’ health and well-being are a top priority. The way I act, communicate, and provide care reflects what kind of nurse I am. It is my duty to ensure that I listen to and understand the needs and wishes of my patients. I 12 not only take care of them physically but also attend to their emotional health needs. Provision three influences me by ensuring that my patients’ rights are known and respected. There have been times in my career where patients have refused care such as taking their medications or getting their vitals signs. I once had a patient diabetic patient who refused to eat although their blood sugar was below normal range. I could not force the patient to eat so instead I educated them of the importance of eating to maintain a health blood sugar. The patient told me they were angry due to a personal issue and did not feel like eating. Knowing this, I gave the patient time to calm down and respected their choice not to eat at that time. I eventually came back to the patient and encouraged to eat in which they did. In this example, I advocated for my patient by educating them and also giving them space and privacy. I did not forsake my duty to provide care but instead listened and tried to understand how the patient was feeling at the time. 2. Nursing error that may occur in a clinical practice A common nursing error that may occur is administering the wrong medication at the wrong time. Nurses are typically responsible for more than one patient. During a shift, many things can occur such as a code, a new order comes in, etc. Due to many things occurring at once, nurse can be easily distracted which can lead to errors especially with medications. An example is when a nurse is preparing a patient’s medication. The nurse should check to see that it is the correct medication, the correct dose, correct route, correct patient, and correct time. Sometimes a nurse may be checking for these things but then gets distracted when a colleague asks them a question. The nurse may come back to checking the medication but mistakenly looks at a different administration time of another medication. The nurse then gives the medication and then when documenting that the medication was given, the nurse realizes it was given at the wrong time. 13 a. ANA provisions applied to the error discussed in part G2. When a nurse makes this error, the commitment noted in provision two is affected. The nurse administered the medication thinking that they had properly checked the orders but instead make an error because they were distracted. The nurse should be diligent and take extra caution when it comes to administering medications because the results can be cause harm to the patient. When an error like this occurs, the nurse is responsible for following the workplace protocols for these types of incidents. The nurse should also notify the doctor and monitor for any changes the patient may experience. This error also applies to provision three because a nurse must advocate for the patient which includes notifying the patient. Since the patient has a right to know what is going on with their care, the nurse needs to admit the error and inform the patient that adverse effects may occur due to the error. H. Leadership qualities or traits that represent excellence in nursing There are many qualities that one can have to be a great leader. Four traits that I believe represent excellence in nursing are compassion, advocacy, integrity, and communication. Compassion is important because I feel that without it, it becomes difficult to give the best care to someone in need especially if it is someone you don’t personally know. Nurses also have a duty to do what is right for the patient by showing advocacy which is to stand up for their rights. Integrity is also an important quality for a leader to have. Having integrity is being able to do what is right at all times. Communication is key to being a great leader because in the leadership role, you may be tasked with having to communicate with many different people. 1. Significance of the leadership qualities in the nurse’s role 14 I personally became a nurse because I wanted to help others and I knew that I would be able to do that by caring for people especially in their weakest moments. A nurse at the bedside that has the leadership quality of compassion can provide comfort to the sick or dying patient; they can provide a listening ear and understanding to the patient and even their family members. During a hospital stay, a patient goes through many things such as diagnostic tests, receiving medications for the first time, pain, and even fear. In my prior experience working as a hospice nurse, I cared for patients’ who were living their last days. Knowing you have only months to live can take an emotional toll on someone in addition to the physical decline they are already facing. Having the quality of compassion was so important as I helped a patient and their family cope and live their final days in the way that they chose. A nurse can also display this leadership trait within the nursing team. Displaying this quality, sets a precedent for others within the nursing disciplinary team to follow because it is important that leaders lead by their example. Another important quality is advocacy. At the bedside, a nurse displays advocacy by listening to their needs and wishes, making sure they understand what is going on with their health, and also by showing respect even in times you may not agree with them. Patients may refuse certain treatments even though their doctor has ordered it for them. A nurse displays leadership by advocating for their patient by giving them proper education of their medications, treatments, and procedures that may be ordered for them. Even if the patient may refuse, the nurse does their due diligence by providing them with the knowledge and allowing them to make their own decisions. Withing the nursing or interdisciplinary team, the nurse can continue to advocate by being the voice of their patients. When the nurse knows the needs and wishes of the patient, the nurse has an opportunity to speak up for them which aids in the outcome of their 15 care. When the whole team is aware of a patient’s wishes, it also becomes a team responsibility to advocate for the patient’s rights. When a nurse has integrity, it brings value and trust to their work and the care they provide to others. At the bedside, a nurse can display this leadership trait by staying true to their moral and ethical values. Nurses can sometimes find themselves in a situation that can compromise their license as well as their morals. It is important for the nurse to speak up when they are asked to do something that may go against their state nursing practice act. For example, a patient complains of pain and ask the nurse for another dose of their medication when it is not within the right time to give another dose. The patient may ask the nurse to lie on their documentation or may tell the nurse that they won’t tell anyone about the extra dose. With the quality of integrity, the nurse can refuse to do this and openly explain to the patient that this violates nursing practice. The nurse can also address their pain by letting the doctor know about their pain which may result in the doctor increasing the dose or changing the medication. Integrity can also be displayed to both the patient and the team which may include other nurses, doctors, nurse assistants and other withing the team. Within the interdisciplinary team, the nurse can display integrity by also speaking up if they are asked to do a task they have not been trained for or may be out of their scope of practice. Lastly, communication is an important leadership trait for a nurse at the bedside. The nurse may be asked by the patient or their family what has been ordered by the doctor. The nurse should be able to communicate well with the patient and their family regarding the care being provided. In nursing school, I was thought that when you step into a patient’s room, you should introduce yourself and also explain what you may be giving or performing on the patient. Communicating with the patient provides a space to be open, honest, and also cultivates a 16 trusting relationship with the patient. Within the interdisciplinary team, communication plays a big role. The nurse can communicate how the patient has been responding to medications and treatments which gives information on how to continue on with the patient’s care. Communication is also important when disagreements within the team arise. The nurse can display open communication by listening and understanding other’s differing opinions and work to come up with solutions that is best for the patient. 2. Impact on work environment I currently work as a nurse in Utilization Management at a health insurance company. My role in this department is to review cases that contain exams and procedures ordered by doctors. I review clinical information and assess for medical necessity for cases that require prior authorization before being performed. My job requires me to be in constant communication with doctors, nurses, and medical assistants and techs. The team I am part of consists of two lead nurses who are available to me as a guide and resource. Their leadership has helped be become a more knowledgeable and efficient for my position. I am always given opportunities to learn and attend trainings that allow me to work in specialized cases. Without the nursing leadership at my job, I would not have direction and guidance in learning processes and protocols set forth in the job. During my training for this position, my leads nurses continued to encourage me and help me through learning new skills. Today, they continue to be a great asset in my workplace, and I am encouraged to continue growing as a nurse. Decision making is a big part of my job. Every day I encounter cases that may be difficult to process. I am responsible to gather clinical information and assess for medical necessity for exams such as MRI’s, CT scans, PET scans, Ultrasounds, and surgical procedures. Though I am given guidelines to follow, I am still required to use my clinical judgement in 17 reviewing a case. I have to decide if what is being ordered meets the criteria for authorization, if additional clinicals are needed, or if further review by a doctor in my team. I also utilize decision making by deciding which cases take priority and needs immediate attention. Professional development is greatly encouraged at my job. My job currently offers up to $5,000 a year of education reimbursement. Due to this benefit, I decided to join WGU and have been able to receive a reimbursement for a portion of my classes. My workplace also provides periodic opportunities for career advancement to a lead nurse or nurse manager position. Having these opportunities and the encouragement of my team challenges me to one day pursue those positions when I am able to.