Nursing Practice
Nursing Theory
Developed by Dorothea Orem, the self-care nursing theory hinges on the assumption that humans have an innate ability to self-care, that humans are independent and have the capacity of self-care and self-correction, emphasizing on individual responsibility in prevention and health education (Jarosova, 2014). In the application of the theory in practice, nurses develop a mutually (patient and nurse) planned program with identified objectives aimed at making the patient understand the required changes in behavior for better health outcomes. The self-care theory fits within the nursing practice in that it helps in the diagnosis of the patient problem (sanitation) and provides remedies to the problem through developing a mutually agreeable plan for changing the patient’s behavior.
Historical Nursing Figures
Among the historical figures in nursing were Mary Breckinridge and M. Elizabeth Carnegie. According to Klainberg and Dirschel (2010), Breckinridge began the Frontier Nursing Service, which provided care for the sick in poor rural communities. She also added midwifery to the Frontier Nursing Service, later becoming the Frontier School of Midwifery and Family Nursing. Carnegie’s contributions, on the other hand, include several publications among them The Path We Tread (Klainberg and Dirschel, 2010). She also fought for the inclusion of Black nurses in the American Navy during the Second World War, at a time when the Navy was discriminating against Black nurses, claiming they (Black nurses) could not be housed in the same bunks as white nurses (Klainberg and Dirschel, 2010).
In looking at the differences in contributions between Breckinridge and Carnegie, while Breckinridge started the Frontier Nursing Service to cater to the poor in rural areas, Carnegie fought for the rights of black nurses. They both were fighting for the downtrodden in society but in different ways. Additionally, while Breckinridge added midwifery to the Frontier Service, Carnegie wrote a book that is in its third edition and helps provide perspective on nursing (Klainberg and Dirschel, 2010). Aside from giving perspective on the history of nursing, Breckinridge and Carnegie’s contributions continue to influence nursing practice by reminding nurses of the need for nursing services. Moreover, they draw attention to the needy in society, as well as the marginalized groups and the need for nurses to cater to all.
State Board of Nursing and American Nurses Association
State Board of Nursing and the American Nurses Association (ANA) have a fundamental difference in their functions. While State Boards are responsible for nurses’ licenses, monitoring, disciplining, education and rehabilitation of nurses ensuring that the nurses are fit and competent in providing their services to the people they serve, ANA’s functions are different. ANA protects and advances nursing as a profession. Ideally, therefore, ANA represents registered nurses and establishes nursing practice standards, while at the same time promotes nurses’ rights in their places of work, as well as advances the economic and general welfare of its members.State Boards draw their roles from the Nursing Practice Act, and through this, their first role is ensuring that nurses practicing meet the minimum requirement for safe practice. To ensure this, therefore, the State Boards’ additional functions include licensing, monitoring, disciplining, and educating nurses. On the other hand, ANA’s roles begin with its allegiance to its members. Therefore, its fundamental role is to protect the rights of its members. Additionally, ANA establishes nursing standards, as well as advances the welfare of its members.
With its role as ensuring minimum requirements for practicing nurses, State Board influence nursing practice by making nurses work to meet the requirements. Moreover, licensing and monitoring of nurses ensure that nurses keep to the minimum required standards of their profession. ANA, on the other hand, emboldens nurses in their practice, knowing that they have someone who looks after their welfare. For the renewal of professional license in the state of Florida, there are minimum requirements. According to the Florida Board of Nursing (2017) for instance, registered nurses require the completion of 24 hours of continuing education, with 2 hours of education relating to prevention of medical errors. Additional requirements include a 2-hour course on rules and laws governing nursing practice in the state, 1 hour of HIV/AIDS, and 2 hours on the recognition of impairment in the workplace (Florida Board of Nursing, 2017). A complete renewal application and payment of the required fees are other additional requirements for renewal.
Meeting the requirements for practice is important. However, nurses who fail to maintain license requirements may get a reprimand, fall into probation, have limited, or restricted practice (NCSBN, 2011). In extreme cases, however, the nurse may get a suspension from the practice, or have the license summarily revoked (NCSBN, 2011).Compact states are states that have mutual recognition, where a license from a compact state allows the nurse from another compact state to practice in another compact state, without the need for a new license (NCSBN, 2011). The nurse can, therefore, practice both physically and electronically in the mutual recognition states (compact). For license in non-compact states, however, nurses have to apply and receive a license that allows them to practice in the said state. Thus, any movement to a different non-compact state will require the nurse to apply for a license.
Food and Drug Administration and the Center for Medicare and Medicaid Services
FDA and CMS have fundamental functional differences. While FDA protects public health by ensuring safety, efficacy, and security of human drugs and medical equipment, CMS provides quality care at lower cost and is committed to being the steward of public funds. Additionally, FDA regulates the manufacturing, marketing and distribution of tobacco with the aim of reducing tobacco use among the minors, CMS, on the other hand, works to strengthen and modernize America’s healthcare system. FDA helps in the advancement of public health through help in speeding up innovation, while CMA provides oversight and collaboration, in addition to providing coverage, reduction of fraud, waste, and abuse (CMS, 2015; FDA, 2017).
FDA and CMS have a great influence on nursing practice. FDA particularly influences nursing profession by regulating the drugs nurses give patients, as well as ease nurses’ work by working on and advancing innovations that help nurses in their work. CMS, on the other hand, influences nurses’ work through the requisite payments made to nurses. CMS regulation of nurses’ pay through Medicaid goes a long way in determining motivation levels among nurses (Ellen & Peter, 2008).Nurses play a critical role as patient advocates. For patients seeking alternative treatment, the role of the nurse is even more critical. It is the responsibility of the nurse in such a case to understand all the aspects of the alternative therapy requested by the patient including cost, drug interaction, the patient’s knowledge of the therapy, and the possible side effects of the treatment (Sue & Linda, 2006).
Purpose of Nursing Practice Act
The Florida Board of Nursing (2007) states that the use of the Nursing Practice Act is “to ensure that every nurse practicing in this state meets minimum requirements for safe practice” (p. 7). The Board further states that the purpose of the Act is to ensure that nurses who fall below the minimum proficiency or are a danger to the public do not practice in the state. For the scope of registered nurses (RN) in Florida, FBN (2007) informs that RNs scope includes but is not limited to the “observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others” (p. 7). The scope also includes medication and treatment administration as prescribed by a licensed practitioner legalized by the state of Florida for medication and treatment prescription. Further, TN scope also encompasses the supervision and teaching of nursing personnel in theory and performance of supervision and teaching.
Concerning the delegation for the RN, FNB defines delegation as the assignment given to a nurse, by either another nurse or a superior. After delegation, the nurse is required to perform the task; however, the nurse has the right to refuse the delegation that he/she considers unsafe.
Nurse Roles in Professional Practice
Nurses play different roles in their profession. As scientists, nurses research the improvement of nursing practice. As scientists, therefore, nurses design studies, analyze data and report results, most of which have the direct impact on patients’ lives and the staff in medical care. Nurses additionally take the role of a detective in that while the detective has a cultivated eyes for detail, nurses too can develop such eyes for detail. Nurses, therefore, observe the smallest in details about their patients and use the information in patient’s recovery. Moreover, nurses ask intelligent questions, which apart from making patients comfortable; also help in collecting necessary information on the patient. Further, nurses are managers as they manage the healing environment by managing the nurses who care for the patients. Nurses additionally recruit and retain nursing staff, and supervise them, while at the same time collaborating with doctors for patient care.
American Nurses Association (ANA) Code of Ethics Provision
At the core of nursing are protection, promotion, and optimization of health and abilities (Epstein & Turner, 2015). In doing these, however, nurses follow the nursing code of ethics that has a number of provisions. Among the provisions is: “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (American Nurses Association, 2015). As a profession that handle’s people at the most vulnerable times, compassion and respect are paramount to the entire nursing practice. The provision for respect and compassion influences everyday nursing practice in that nurses must remain vigilant, yet compassionate and respectful to patients regardless of their standing in society. It is for this reason therefore, that nurses serve everyone including the homeless and even those without medical cover. Compassion and respect for human dignity and life influence the nurse’s decision to assist the patient without any prejudice.
Another provision states: “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” (American Nurses Association, 2015). This points to the patient as the first priority for all nurses, who should then work to ensure that patients get the best care possible. According to Epstein and Turner (2015), part of nursing as a profession is “advocacy in the care of individuals, families, communities, and populations.” The nurse’s commitment to the patient, therefore, involves advocating for the right of the patient, especially in accessing healthcare. It is because of the commitment to patients that pushes nurses to advocate for patient rights, better healthcare and health supplies that help them in providing the best healthcare possible to the patient.
Even with their training and experience, it is possible for nurses to make mistakes in the clinical setting. For instance, nurses may make medication errors such as an overdose, an underdose, or completely skipping giving a patient medication, especially in a busy setting such as a medical-surgical unit. The pressures of such a unit can be the reason for such a medication error. However, provision eight of the code of ethics for nurses states: “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities” (American Nurses Association, 2015). The provision allows for collaboration as well as the creation of a culture that allows nurses to ask questions regarding the profession without the fear of victimization or anxiety, all of which help in reducing such errors.
Leadership Qualities
Leadership is an important aspect of all professions. Leaders set the goal and objectives their followers work to attain, as well as provide the means to achieving the goals and objectives. In the business world, leaders are among the most valued employees within the organization. Similarly, in nursing, leaders within each department are core to providing the best care and enhancing positive patient outcomes. Leadership is both inherent and learned, wherein some people are naturally gifted as leaders, while others learn how to become good leaders, perfecting the skill with experience. Given the sensitive nuances that come with nursing, nursing leaders should possess a number of leadership qualities. According to Cherry & Jacob (2014), these include emotional intelligence, integrity, critical thinking, and communication skills.
The aforementioned qualities are significant for nursing both at the bedside and within a nursing team. Emotional intelligence at the bedside helps nursing leaders to not only empathize with the patient but also empathize with the family of the patient. Moreover, emotional intelligence enables the nurse to read the mood of the patient and the family members and find the most tactful and humanely possible way of delivering bad prognosis, such as terminal cases. Integrity at the bedside, on the other hand, enables the nursing leader to tell the truth to the patient, provide the right medication, as well as charge the right cost for medication without inflation. Critical thinking at the bedside helps in making decisions based on patient history and medication regimen. Cherry & Jacob (2014) inform that critical thinking on the part of the nursing leader at the bedside is important as it allows the leader to make decisions that may be instrumental in saving the lives of patients. Moreover, the nursing leader should have good communication skills in giving instructions to patients and collaborating nursing regarding medication and care of the patient for improved health outcomes.
Within a nursing team, emotional intelligence is important for a nursing leader as a means of not only helping trainees develop the skill but also helping peers cope with stressors. Emotional intelligence additionally assists in helping team members overcome challenges, which may be counterproductive to the team. Integrity, on the other hand, helps leaders make the right choices within the team as well as teach ethically sound practices to team members. Critical thinking, on the other hand, is important for nursing leaders as it helps them guide the unpolished practitioners (Cherry & Jacob, 2014). With a continually growing autonomy for nurses, teaching members of the team critical thinking and allowing them to hone it makes the skill valuable for the profession. Finally, nursing teams sometimes involve multidisciplinary groups. Nursing leaders with good communication skills are better placed to increase collaboration within such teams. Communication skills are therefore a necessity for such teams for easy collaboration and improved patient outcomes.
Work Environment
Work environment is one of the most important factors for employees. According to Balsanelli and Cunha (2014), the work environment is important in honing nursing leadership. They argue that a work environment that encourages autonomy and has collaborative relations helps leaders hone their skills, while the opposite is true for controlling work environments (Balsanelli & Cunha, 2014). Work environment additionally had an impact on leadership and nursing decision-making. For collaborative work environments, practitioners are more likely to stay, being satisfied with the working environment, while at the same time working to improve patient outcomes and reduce mortality. However, the dissatisfaction levels are usually particularly high in uptight working environments, which then cause many professionals to not only make decisions to leave the station, but also care less about patient outcomes (Balsanelli & Cunha, 2014). Even more, is the impact of work environment on professional development. to Balsanelli and Cunha (2014) posit that a positive working environment with transformational leadership not only encourages nurses to remain in their current positions but also go back to school for professional development. Positive working environments, therefore, not only encourage employee retention but also acts as a magnet for potential employees, while encouraging incumbents to work towards self-improvement.
References
American Nurses Association (2015). Code of ethics with interpretative statements. Silver Spring, MD: ANA. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-ofEthics-For-Nurses.html.
Balsanelli, A., P. & Cunha, I., C. (2014). The work environment and leadership in nursing: An integrative review. Revista da Escola de Enfermagem da USP, 48(5). Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342014000500938.
Cherry, B. & Jacob, S., R. (2014). Contemporary Nursing: Issues, Trends, & Management (Cherry, Contemporary Nursing), 6th ed. St. Louis, Missouri: Mosby
CMS (2015). Getting to Know CMS-Short Version.
Ellen, K. & Peter, B. (2008). New Medicare payment rules: Danger or opportunity for nursing? American Journal of Nursing, 108(6), 30-35.
Epstein, B. & Turner, M. (2015). The nursing code of ethics: Its value, its history. Online Journal of Issues in Nursing, 20(2). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html.
FDA (2017). What we Do. Retrieved from.
Florida Board of Nursing (2007). Nurse Practice Act. Florida Department of Health.
Florida Board of Nursing (2017). Registered Nurse (RN). Retrieved from
Jarosova, D. (2014). Nursing Theories and Models. Universitas Ostraviensis
Klainberg, M. & Dirschel, K., M. (2010). Today’s Nursing Leader. Jones & Bartlett Learning
NCSBN (2011). What you need to Know about Nursing Licensure and Boards of Nursing. NCSBN
Sue, F. & Linda, N. (2006). Complementary and alternative therapies: The nurse’s role. Journal of Neuroscience Nursing