PROFESSIONAL ROLES AND VALUES
Running Head: PROFESSIONAL ROLES AND VALUES TASK ONE
PROFESSONAL ROLES AND VALUES TASK ONE
A. Nursing Theory
Dorothea Dix’s work, which I would call as the pioneering theory and paradigm to treat the mentally ill, has inspired me all through my career because of its groundbreaking contribution to our national and global mental health practice and its robust relevance to today’s knowledge. Her work made essential observations as to how to properly treat persons with mental health disorders. She proposed separate care homes (state hospitals) for people with mental health conditions, argued with evidence that they could not be placed with non-mentally-ill persons, and strongly emphasized the role of authorities in the plan and process of care to people with mental disorders. Her research, its advanced propositions, and its findings are still relevant today. In addition, her insight for the training of the caregiving staff and her firm belief (against then distorted view) that the mentally sick can be cured are all groundbreaking work still followed to a great degree today. (Bumb, n.d.)
A1. Excellent Nursing Practices
The paradigm, discussed above, was an excellent effort to advance nursing practices and manifold in the centuries to come. The paradigm bound the health care industry to view mental illness from a positive perspective that these patients could be cured. It changed everything we do for the mentally ill: the system, the focus of care, and different training of nursing are just a few examples of what Dix helped to bring forth in the mental health field. Because of Dorothea Dix, it is practical to relate that today mental illness is treated from social, psychological, biological, and spiritual domains. Modern psychiatry has made tremendous strides given the contributions of such historical figures as Dorothea Dix have made. Thus, mental health as is known today finds inspiration and practical guidelines from Dorothea Dix (Unterrainer, Lewis, & Fink, 2014).
A2. Professional Practice Nursing Theory
Dorothea’s framework influences my professional practice in terms of my goals and values in many diverse ways. I always keep in view the fine sensitivities that Dix has highlighted while treating my patients. I aim at continuing to develop as a nurse leader in the mental health field, and strive to deliver the best quality of care to my patients by basing my efforts off the footprints Dix laid. The methods used in the mental health field in regard to medications and techniques fifteen years ago are no longer used today. This is because of the efforts of Dix; she paved the way to innovative thinking. As new technology advances, education advances and the scope of nursing expands, we (nurses) are able to continue to carry out the framework of shaping a proper mental health treatment system.
Furthermore, the positive view Dorothea lent us that guides me today is: Mental health is not a stigma but a disorder that, like physical illnesses, can be cured. The only thing we need is a different worldview, compassion, and knowledge of how psychiatric illnesses are to be treated. Thus, my professional skills have benefitted an excellent deal to this day, and I continue to benefit from Dorothea’s important work. Her legacy is invaluable and will continue to steer me throughout my journey as a nurse.
B. Contributions of 19th or 20th Century Historical Nursing Figures
Florence Nightingale (1820-1910).
Florence Nightingale had wanted to work as a nurse, but her parents did not permit her. However, she did not lose her hope. She joined a nursing school in Germany. Soon she was transferred to a hospital in London. It offered health care to wounded soldiers that were fighting in Turkey. It was her experience that helped her to later establish the Nightingale Training School in London. The branches of the school are now open in many countries. One of the critical issues Nightingale focused was meager sanitation and healthcare provision of military men. Thus, her work is known in the area of care planning, and standardization of many processes still used today (Selanders, 2018).
Margaret Sanger (1879-1966)
Margaret had a life full of challenges in her early days. She committed, in the wake of her mother's sad demise, to teach women about reproductive and general health. By this time, she had had considerable experience as a nurse and made this commitment. Thus, her profession and personal turbulences had her pledge to work for the betterment of other women: Her mother had to face seven miscarriages before finally losing it all. Margaret's painful experience of observing her mother and life around her, her training as a nurse, and her commitment to educating women about reproductive and sexual health has saved many people to this day. She opened birth control clinics nationwide as a pioneer of the field. Her teaching and counseling included many other areas for women's awareness. She also contributed in magazines and wrote books on this topic. Contraceptive prescription law for families became possible in 1927 because of her effort (ANA, 2013).
B1. Differences in Contributions
Discussed above are two historical personalities have contributed immensely to the nursing profession in different domains. Nightingale's work is influential for increasing patient safety for physical wounds and injuries. Her significant share is identified in developing hospital systems for planning to such professional levels that to this day some of these are still used in nursing. Similarly, Margaret's contribution is influential in the women's health domain. Women's reproductive health, awareness about varying women-specific issues, and safety education are her key works that molded nursing to develop as a profession (Selanders, 2018; ANA, 2013).
B2. Description of Historical Figures
It is manifest to note the historical contribution of these two figures in helping us develop nursing practices in the modern context for improved care. As a psychiatric (mental health and substance abuse) nurse, I find their tenets quite relevant to my practice, particularly regarding safety and overall wellbeing. For examples, Nightingale introduced safety procedures for patients’ safety in hallways and accidents. Since I deal with a population of mentally ill patients such guidelines are invaluable for me (and other nurses in general care) to handle safety issues on a daily basis. This ties into my line of work in many ways, however an example of the most frequent safety issues encountered daily are due to patients having medication adjustments, or new medications added that lead to falls or other injuries. Safety is of utmost importance in all delivery of care for all patients. Margaret's work has lent tremendous insight into current health care, and her foundational work helps us in dealing with female patients that struggle with reproductive issues. I chose to utilize Sanger’s contributions because it is necessary to acknowledge the specific degree of reproductive issues women face as they lead to other challenges. Oftentimes, our acute care hospital is seeing an increase in census on both the behavioral side of the hospital as well as our substance abuse side of the hospital. During the intake assessment, the nurse learns why a very healthy and productive young woman has fallen prey to alcohol or drug abuse or has fallen into a deep depression: the inability to conceive.
C. State Board of Nursing Versus ANA
The state board of nursing carries out a vital function by ensuring people's health by setting certain standards to be met by licensed nursing care providers. It regulates the scope of this profession and offers a regulatory framework and licensing. It is the main body to issue a license to a nurse. In contrast, ANA is an umbrella entity which works to advocate registered members' (nurses) interest and to represent them (millions of nurses). The major role of ANA is to ensure all people receive better care as their members collaborate extensively to chart out consultation-based guidelines to improve each other's practice (ANA, 2015; Huntington, 2016).
C1. Roles of Organizations
The fundamental area of function of these entities is to put effort to make sure quality health care is delivered to all people. These bodies also commit to safeguarding nurses’ rights by highlighting their grievances and needs to the concerned authorities. These bodies also have a central function with ensuring that skills and competencies of our nurses are up to the mark. For this purpose, they strive to offer training and updates per current knowledge base (ANA, 2015; Huntington, 2016).
C2. Influence of the State Board of Nursing and ANA
The state nursing board defines my professional practice (roles and responsibilities) as a nurse. To ensure that I do not get my license revoked, I must observe and adhere to all of the relevant rules and regulations of the board of nursing. In contrast, ANA is a platform on which I can further hone my skills and competencies to serve my patients more effectively. On the ANA platform, I get regular inspirational stories from my colleagues from different locations; it drives my passion for serving even better. In short, working for different aims, these two entities strive for us to work for better and safer care for all of our patients.
C3. Requirements for Professional License Renewal
North Carolina Board of Nursing (NCBON) requires the following for professional license:
The aspiring RN must complete designated hours of a professional nursing program from the NCBON approved schools. It can be both within the state or in another state. However, NCBON accreditation and approval is mandatory. The state has approved diploma, associate, and baccalaureate level programs. One must make application to the North Carolina Board of Nursing, and pass the NCLEX examination if he/she is a new graduate nurse. One may also apply through reciprocity via their home state.
One must renew their license every two years, by the end of their birth month. The fee is hundred dollars. The nurse must also complete one of the following: fifteen continuing education hours with six hundred and forty hours of active practice (within the preceding two years), obtain a national certification by a credentialing body, or thirty hours of continued education. One may also complete two semester hours of post licensure academic education related to nursing practice or a board refresher course.
A license can be placed on an inactive status if a nurse fails to demonstrate that the requirements for renewal have not been met. A new license will not be issued until all requirements are updated. (NCBON, 2018).
C3a. Failure to Maintain License Requirements
NCBON (2018) does not mandate maintaining the license. It is required that the candidate review his or her license by the last day of their birth month; however, failure to do so will lead to automatic expiry of the license at midnight of the final day. The board, 90 days prior to expiry, also emails a reminder for renewal. With an expired license, the RN cannot practice as a Licensed Practical Nurse or a Registered Nurse. The nurse must reapply for the license renewal before actively practicing again. The fees for renewal is $100 (inactive) and $180 (expired). Legal action can be taken against the nurse that practices with an expired license.
C4. Compact Versus Non-Compact State
A registered nurse with a compact license is allowed by the law to practice in a multistate setting. This could be done through electronic service provision or being physically present in another state. With the compact license, the nurse can also offer services from states that are within the nursing compact states. There are 25 states that offer a compact license, and the nurse must be from one of these states to obtain a compact state license while fulfilling the requirements for training and education. The compact states have the same nursing guidelines and standards.
On the other hand, to work in a non-compact state, a nurse with a compact license has to obtain that state stat specific license. Moreover, the professional with a non-compact state license cannot work in compact states though she/he can apply for a license in that compact state. However, there is a difference. If a non-compact nurse obtains a license to work in a compact state, she/he can work only in that state but not in any other compact states. It implies that the non-compact nurse has a limited scope of professional services as her privileges are limited compared to compact nursing practitioners that can offer their services in multistate context (NCSBN, 2014).
D. Agencies Functional Differences
The FDA regulates the market-related issues of medical supplies (drugs, devices, etc.). The CMS regulates fund allocation for many health care related services and products for their programs. Medicaid and Medicare are two of the largest programs in the US. The FDA has the responsibility to regulate drugs, devices, biological products, etc. for the early phase (before marketing). This involves measuring the safety and efficacy of the drug and product to approve it or otherwise. FDA also closely watches an approved product after it is marketed for its safety and efficacy by measuring emerging data (FDA, 2018). CMS controls the main course of our health care system. The focus of CMS is to ensure that current and adequate health coverage is provided to the citizens. CMS also strives for the modernization of our health care industry in which both patient and the practitioners cocreate resilient pathways for better health care that benefits the patient, the hospital, and the system at large (CMS, 2018).
D1. Influence on Professional Practice
Over the course of one’s nursing practice, a nurse will learn about many issues such as a drug shortages, adverse effects, device malfunction, and many more issues that involve regulatory agencies. The FDA is the authority to be reported for such issues, and as a practitioner, it is my responsibility to bring to FDA’s notice these issues to ensure we all work for our patients’ safety and rights. FDA and relevant bodies also emphasize this role. Recently, such issues are being reported more and more (Karch, 2014), and following FDA guidelines becomes all the more important for us as advocates of our patients’ rights. Following FDA guidelines as translated by ANA is also all the more relevant today (Swayze & Rich, 2011).
Hospitals must follow specific CMS guidelines (Conditions of Participation (CoPs)) to qualify for funds for Medicare and Medicaid programs. The CoPs include many essential areas of focus such as cutting down on the rates of pressure ulcers, catheter-associated urinary tract infections, patient seclusion, restraint use, etc. The ANA is always in dialogue with CMS to continually negotiate better terms for nurses. As CoPs have serious legal implications, nurses must also follow these rules. Thus, CoPs assists to direct and shape professional practices as a nurse (ANA, 2018a).
D1a. Nurse’s Role as A Patient Advocate
In the light of the FDA and CMS offered guidelines, it is imperative that a nurse advocates the patient rights, safety, and interests by playing an active role by pointing out any concerns she/he may find out. For example, the nurse is obliged to report medication errors, adverse drug advents or any clinical concern that is not in the best interest of the patient, such as abuse or neglect. Likewise, the nurse must also closely follow any new rules/standards so that her patients' safety and rights are ensured. However, if she/he comes across an unfavorable scenario while performing her duty, she/he must bring it to the notice of her coworkers, management, and CMS/FDA. She/he can also report it to the nursing networks if nothing is working so that together they can voice for the patients’ rights and quality of health care (which is our fundamental role) (Whyte, 2016).
E. Purposes of The Nurse Practice Act
Made effective more than a 100 years back, there are several aims that Nurse Practice Act (NPA) has. One of its primary goals ensures that unskilled care providers safeguard everyday citizens. It also works to ensure the care providers are abreast with current practice discourse, skilled, and competent so that they offer quality health care. Nursing today is becoming a growingly mobile job with diverse nursing careers being pursued in different care contexts. Thus, patient safety has taken new forms, and harm to a patient may be more relevant. Therefore, under NPA, both federal and state laws can hold the nurse accountable for her practice (NCSBN, 2017). I am duly informed by the scope of the NPA as I carry out my professional role and responsibilities. Any decisions I take, I must be aware of and conform to the provisions of NPA as relevant to my state and federal guidelines.
E1. Scope of Practice
In my state, North Carolina, the scope of practice for a registered nurse is to make sure that the nurse follows the specific scope of practice (that is, there are different scopes for different professionals). The state provides regulations and standards for all nurse's to accurately follow and ensure legal practice to serve in the role and provide care for which they have acquired the education and license.
E2. Rules for Effective Delegation
The RN in NCBON is an independent professional, whereas license practice nurse (LPN) is not independent. Both have different scopes of practice. Similarly, unlicensed assistive personnel (UAP) carry a different mandate for effective delegation by either RN or LPN. The RN can carry out essential functions such as comprehensive assessment, planning care, developing the plan, its implementation, and, eventually its evaluation. Whereas, an LPN has the participatory and suggestive scope in all these phases. The nurse cannot make an independent decision but needs to be supervised by the RN. Both can report and record (Position statement, n.d.). There are rules for an RN and LPN to delegate care to UAP. Major considerations require the task to be (I) within the scope of practice of an RN; (II) upon completion of assessment; (III) RN/LPN's competence to delegate; (IV) the rules must be consistent meeting all the criteria; (V) UAP must be well trained; (VI) agency policies must be confirmed; (VII) must be done under adequate supervision. Moreover, one of this criterion not meeting, the task cannot be delegated to the UAP (Winstead, 2015).
F. Application of Nursing Roles
Several roles and duties are performed by a nurse as a scientist while caring for her patients. In my role, working as a scientist involves having a keen eye on the environment around me at all times. I need to be aware of not only my physical surroundings for safety of myself an others but I need to continuously monitor the patients well-being for medication interactions or adverse effects. I need to constantly be in the mode of being able to identify and detect an issue and respond promptly and accordingly. I must have the ability to collects data, analyze the evidence and employ established ways (EBP knowledgebase, reflection, multidisciplinary consultation, ieetc.) to reach a conclusion. Once evidence is acquired through this recursive process, I must be able to create a corrective action plans when deemed necessary.
As a nurse detective, I have the responsibility to assess a patient’s health and to find out if his/her condition is changing for the better or worse. For example, I must have a close eye on the lab-values of my patients. I must be able to share any irregular health signs with my interdisciplinary team members. Moreover, as the nurse detective I must follow-up with the outcome of new standards for the issues that I identify to improve patient safety and outcomes.
As the nurse manager of the healing environment I am primarily concerned with ensuring an overall clean and sanitary environment as well as safe and nutritious food for my patients. I strive for adequate resources for better care provision. I work toward making the hospital a peaceful place for everyone. I am also an activist of patients' rights, their satisfaction, and better overall care.
G. ANA Code of Ethics Provisions
Following two provisions are more relevant to my area of practice:
1. Provision 1: “The nurse, in all professional relationships, practices with compassion and the recognition of human dignity and worth that is present in every individual”.
2. Provision 3: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient”. (RN.ORG, 2018).
G1. Analysis of Provisions
The first Provision is related to my area of expertise as it encourages me to observe respect, compassion for my patients as I truly know their worth and dignity. Therefore, I, as a mental health nurse, know that there are many factors at work such as diverse coworkers and clients, cultures, belief systems, socioeconomic backgrounds, and so forth. Hence, this provision guides me to be sensitive to many such variables while I carry out my duties in order to be a positive contributor to my facility and work for a resilient environment that heals all of us (not the patient only) (ANA, 2018b).
The third provision guides my professional duties in relation to my advocacy for patients and to watch for their safety and rights and to promote their health care. This provision is dear to me since I have chosen this profession to serve others in their time of need, and so I vow to go to any length to help them within ethical and practical bounds to ensure their safety and health: consultation with other practitioners, departments, and stakeholders is an essential part of my mission. Patient involvement in their care plan is another important step I keep upfront (ANA, 2018b).
G2. Clinical Practice Error
An example of a clinical practice error would involve administering the wrong medication. For example, a nurse may incorrectly the wrong dose of the medication Norco to a patient because he/she became distracted during the medication administration pass. This resulted in given the patient a larger than prescribed dose. The nurse immediately assessed the patient upon discovery of the error, reported the error though the appropriate channels per policy and completed necessary follow-up with the patient.
G2a. Application of ANA Provisions
The two Provisions noted above, and provision five are relevant to this error. The nurse involved had the responsibility to act professionally, and the error is not in line with that. Yet, reporting the error is professionally aligned, In addition, it was most likelythe ethical and moral principles that guided the nurse to make the correct professional decision. The nurse stood behind her ethical belief system to ensure her patient was safe, despite possible consequences for the error.
H. Leadership Qualities or Traits
Resilient nursing practice involves quite a few traits and qualities of leadership. Here, I will discuss the major ones: compassion, communication, respect, and competence.
Current literature posits that compassion is an integral part of human nature. Therefore, as human whatever we do, our compassion is at its base. As a nurse leader, use of compassion becomes far more relevant because our actions must demonstrate it. We must be polite to our patients/families, listen to them with empathy while attending them at the bedside to fully understand the patient’s pain and difficulty. In general life, compassion is necessary for positive impact. Nursing thus needs it all the more.
Effective communication is another essential attribute of nurse leader closely related to compassion. When at the bedside, the nurse should pay attention to the patient's both unspoken and expressed needs. The nurse is also responsible for educating the patient on the right and ethical ways regarding their health and recovery. By communicating effusively, the nurse leader can efficiently manage her floor because it creates an air of mutual trust and understanding, showing by doing, and consultation for quality care delivery.
Respect is another valuable trait. It is needed for self, co-workers, patients, their families, and others around us so that the nurse leader serves her client staying above any types of biases and barriers such as race, religion, beliefs, gender, and culture. Respect is equally relevant when at the bedside the patient may disagree with you because of worldview and cultural differences. The nurse must always be respectful of a patients thoughts, feelings an cultural sensitivities and put ours aside.It is relevant in teams and the broader environment. When respected, anyone would feel empowered and will have a say to contribute meaningfully to the betterment of the environment. Thus, respect is a prerequisite of leadership.
The competent nurse stays ahead of the game by striving for her patient’s recovery and health. It requires that at the bedside she knows her patient and involves him/her in the planning of care while putting effort to arrange for resources needed for care by consulting with other staff in the setting. This effort makes care probes useful and reachable. The nurse with this leadership quality is the one who can do such roles competently.
H1. Demonstration of Nursing Leadership Qualities or Traits and H2. Work Environment
Compassion is at play when the nurse feels for her coworkers' challenges who may have a rough routine. She should come forward to extend a helping hand, listen to them, and assure they are sleeping well and eating healthy and drinking plenty of water. She should do a little extra watching the patient of her coworker who may want some time out. Compassion is at work when we know the coworker has a personal problem: We can listen to them and offer a solution if feasible. In a multidisciplinary team, compassion is effective as well (anesthetist, x-ray technician, physicians, respiratory therapist, and so forth). Our teams should be aware that we are here not just for the paycheck but understand others as humans also.
Communication is the glue in my view which sticks in one place all the roles and duties that we do. A day without communication probably is unimaginable. Developing a plan of care, information and data sharing, evaluation, lab stats reading, decision-making, etc. are based on effective communication: accurate, concise, and polite. It is relevant to every stakeholder: our colleagues, the patients, and their advocates/families.
Respecting others, such as personnel above us for the authority they have, and those under, realizing their capabilities, is an essential attribute of the leader. I must respect my colleagues the same way as I expect them to do it with me disregarding their backgrounds and other variables.
Competence in a professional context must be a priority. We should strive for life-long learning so that we can get better and better and lead our juniors effectively while encouraging them to grow professionally like us. Competence is also invaluable because nursing-related feedback is highly needed to assist multidisciplinary team members like doctors, managers, and technicians. A lot of times, another team member can overlook aspects of patient care, but important input by the competent nurse can be critical for both the patient outcome and the hospital.
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