PROFESSIONAL 10
Professional Development Plan
Grace Argentino
Ferris State University
Professional Development Plan
The purpose of this paper is to evaluate and to analyze my professional standards in nursing against the American Nurses Association (ANA) Standards of Professional Performance, with the intent of developing a plan for professional development through the use of goal setting. My professional development plan will include goals that reflect areas of weaknesses, as identified through the analysis of my current professional practice standards, and the methods used to evaluate progress towards achieving those goals. The following paragraphs will contain a brief comparison of my standards against those of the ANA. According to the book The Essential Guide to Nursing Practice, “The ten Standards of Professional Performance are ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health” (American Nurses Association [ANA], 2012).
Standards of Professional Performance
Ethics
Ethical standards of nursing at set through guidelines established by the ANA in the Code of Ethics for Nurses. The purpose of the Code of Ethics is described as, "It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession's nonnegotiable ethical standards. It is an expression of nursing's own understanding of its commitment to society" (ANA, 2001). Under their nine provisions, a framework is created to guide nurses’ decisions on issues such as the nurses’ commitment, advocacy and patients’ right, responsibility and accountability, and obligation towards professional growth and competency.
In my own ethical standards, I try to closely follow the nine provision listed in the Code of Ethics. As a new nurse to the emergency room, it can be challenging to treat all patients with compassion and respect, especially when they do not always have the same responses towards you. I try to the best of my ability to treat all patients equal, setting aside bias opinions, and treat them with the compassion and respect they deserve. As stated in The Code of Ethics and followed within my practice, my primary commitment is to my patients. I am finding emergency nursing puts me in a direct position to advocate for my patients. Coming from a night shift position, my access to social/case management was often limited. Now, with the availabilities of physicians and social workers at my fingertips, I am better able to advocate for my patient’s needs.
Although I am confident in my abilities, the emergency room can be intimidating to a new nurse. I am continuing improving in the area of delegation. As stated in the Code of Ethics, "...nurses are accountable for the assignment of nursing responsibilities to other nurses and the delegation of nursing care activities to other health care workers"(ANA, 2001). As I am quickly learning, the environment I work in requires trust in the abilities of those who surround me. I am surrounded by emergency medical technicians, paramedics, patient care technicians, and other nurses, all of which hold different capabilities and scopes of practice. In time, and with experience, I am confident I will improve on my delegating abilities.
Education
The ANA's stance on education, according to The Essential Guide to Nursing Practice (2012) states, "Education is requisite for acquisition of the knowledge, skills, and abilities needed to maintain current, safe, and effective clinical practice. The ability to acquire, appraise, and apply the best scientific evidence in nursing practice is sustained through ongoing professional education" (p. 123). Because of the continuing advances in technology and medical treatment, I have taken every opportunity to continue my education in efforts to expand my knowledge base and become a well-rounded nurse, including enrolling in the BSN program at Ferris State University.
My previous unit, and orthopedic/neurological medical-surgical unit, required knowledge of specialized treatments, procedures, and equipment that was unfamiliar to me. In an effort to comply with my obligations, I voluntarily attended hospital offered educational conferences hosted by our surgeons. I also complied with unit specific mandatory educational requirements by obtaining certifications in epidural spinal anesthesia, wound V.A.C therapy, cervical-spine precautions, stroke certifications, and many other specialized training for the unit.
In my new position, I will require additional knowledge, skills, and abilities to provide safe effective care. Emergency nursing requires specialized education in trauma nursing and a multitude of certifications I do not currently possess. I will be required to obtain Advance Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nurses Core Courses (TNCC) certifications, as well as attend mandatory monthly educational offerings through my department. At this moment, my current weaknesses in educational requirements, as compared to the ANA's standards, are identified as the lack of knowledge of trauma nursing and the advanced training in life support measures.
Evidence-Based Practice and Research
The ANA (2012) has included evidence-based practice and research in their standards of professional performance, stating “Grounding nursing practice in evidence, rather than tradition, is necessary to meet nursing’s social obligations of accountability to use current evidence-based nursing knowledge-including research findings-to guide their practice” (p. 134). I feel the hospital policies and procedures I follow are evidence-based, designed to provide the patient with the safest and best possible outcome. Since I am still new to my department, administrating medications I have never administered before, I am finding myself referencing our policies and patient care guidelines to ensure I am practicing safely.
Melnyk, Fineout-Overholt, Stillwell, & Williamson (2009) state, "every day, nurses perform interventions (for example, administering medications, positioning, suctioning) that should stimulate questions about the evidence supporting their use" (p. 49). In my professional practice, especially on orientation to a new department, I am constantly questioning the reasoning behind the interventions I am being taught. For instance, I recently had a patient who had a stroke, and was not a candidate for TPA. Her systolic blood pressure was just over 200, and she was about to be transferred to a unit. When I questioned my preceptor the reasoning behind not treating the blood pressure, she explained evidence-based practice says a high blood pressure will help sustain perfusion to the brain.
As compared with the ANA standards, my weakness lies in the area of research rather than implementing evidence-based practice in my nursing. I have never participated in or conducted any research on my own. We do have a group of nurses that participate in unit-based research projects throughout the year. In the future, as my comfort in the department grows, I would like to participate in those projects.
Quality of Practice
“The registered nurse (RN) contributes to quality nursing practice by assuring that patients receive evidence-based care that is patient centered, safe, effective, timely, efficient, and equitable”( ANA, 2012, p. 145). My practice standards are to provide patients with quality, safe, effective care. On my former unit, I helped achieve this by participating in weekly safety rounds and being a member of the unit's shared governance committee. Participating in weekly safety rounds allowed me to share information with other units on what my unit was doing to maintain our patients' safety, such as the implementation of turn teams in an effect to reduce pressure ulcers. Becoming a member of the shared governance committee allowed me to contribute input on what the unit could do to improve the quality of our care on the unit. We implemented a pilot study of purposely hourly rounds, in which a staff member would purposely round on patients in an effort to more efficiently attend to their needs. I think the key to quality practice is consistency, which is why I try to bring those same principles used on my previous unit to my new department.
Communication
The ANA’s standard for communication states (2012), “The registered nurse communicates effectively in a variety of formats in all areas of practice” (p.153). Communication is a major part of my nursing practice, as I regularity interaction with a variety of individuals on a daily basis. I interact with attending physicians, residents, medical students, other nurses, and many other members of the healthcare team. Effective and clear communication is an essential component to what I do. I have become proficient in using therapeutic communication techniques, including both verbal and nonverbal, as way of establishing a relationship with patients. It can create an atmosphere that conveys trust and understanding at a time when patients are their most vulnerable, allowing them to feel safe to confide in me. It has become obvious to me already, in only a short few weeks, my area of weakness in communicating will be in the trauma bay in the mist of all the chaos. This is expected of all new employees, which is why new ER nurses must have the proper experience and training before working in that area.
Leadership
“The registered nurse demonstrates leadership in the professional practice setting and the profession” (ANA, 2012, p.163). Leadership can be described as, “…ability to influence others towards accomplishing common goals” (ANA, 2012, p. 163). Leadership comes in a variety forms and happens over many different settings. For instance, on my previous unit, although not in management, I was charge nurse several times. In that position of leadership, it was my responsibility to make sure other nurses and ancillary staff completed their assigned tasks. I was responsible and held accountable for the unit activities during my scheduled shift, such a staff scheduling and maintaining narcotic counts. In my everyday nursing practice, I am a leader to those around me. I believe leaders motivate, inspire, and influence others to their fullest potential. When I am working with others, I bring an energetic and positive attitude to help contribute to a positive atmosphere. I acknowledge those around me for their hard work and dedication, and try to encourage those who need it.
Collaboration
“The registered nurse collaborates with the healthcare consumers, family, and others in the conduct of nursing practice” (ANA, 2012). I incorporate the standards set forth by the ANA for collaboration by effectively functioning within an inter-professional team setting. In the emergency room, I work closely with all disciplines of healthcare to provide patient-centered care. Collaboration requires strong communication, teamwork, and a coordinated effort of all involved to ensure a patient's needs are met. I collaborate daily with residents, attending physicians, other nurses, respiratory therapist, and many other members of the healthcare team, to provide patients with the best possible outcome. I use collaboration to provide better patient outcomes and improve their safety. For example, being part of the inter-professional team allows me to share my assessment findings with other team members, such as the attending physician or the respiratory therapist. This allows for the use of integrated interventions from other team members who specialize in specific areas of healthcare that will improve my patient's condition.
Professional Practice Evaluation
“The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations” (ANA, 2012, p. 187). I display the attitudes and behaviors expected of me as a member of the profession of nursing by adhering to the legal framework of the law, practicing within the scope of my practice, and following the hospital’s policies and procedures. I maintain current licensure, as required in the state in which I practice. "The degree of professionalism displayed by nurses in the workplace can directly influence how they are perceived by others" (Primm, 2010). I am perceived by others based on my professional behavior, which is why my actions exhibit values such as equality, responsibility, accountability, advocacy, and honesty.
I remain competent in my knowledge and skills by seeking professional growth and development opportunities, and obtaining the certifications necessary to provide patients with standards of care they require. I recently asked to shadow our respiratory therapist so I may gain more experience in caring for patients with tracheostomies. I am enrolled in the next upcoming ACLS class in the fall to obtain the mandatory certification for working in our resuscitation bay.
Resource Utilization
“The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible” (ANA, 2012, p.193). In my nursing practice, I have become more financial aware of how my actions financially affect my patients and the hospital. In the past couple of months I have become more cost conscious in my care by only bringing the necessary supplies to get the job done, wasting medications not being administered, and only bringing one IV bag into a patient's room at a time. Working in the emergency room allows me direct access to case managers and social workers, who may assist in directing me to the proper resources for my patients. I encounter patients daily who use the emergency room as their primary care facility and cannot afford to pay for their prescriptions. I regularly provide patients with information on free clinics and free prescription programs offered in the community.
Environmental Health
“The registered nurse practices in an environmentally safe and healthy manner” (ANA, 2012, p.201). The ANA (2012) also states, “…all nurses need to acquire basic knowledge of scientific environmental health concepts, including the basic mechanisms and pathways of exposure to environmental hazards; prevention and control strategies; and interrelationships of individuals, communities, populations, and the environment, including the workplace” (p. 204). Most of the employees of the department also participate in community projects to promote a health environment in the community. I have not had a chance to participate in these events as of yet, but I do plan to participate in them in the future. The ER has a "green team", designed to implement project ideas, such as recycling projects and the use of eco-friendly cleaning supplies.
Professional Development Plan and Goals
After review of each of the definitions of the ANA Standards of Professional Performance, a comparison of their standards against my own practice identified several areas for continued growth and development. I feel the majority of my weaknesses lie in being a novice nurse with less than two years of experience. I believe Shirey (2009) describes the early stage of a career appropriately as "...enter into their first registered nurse position; build their knowledge, skills, and abilities; get exposures to a wide variety of experiences; figure out where their strengths lie; and position themselves to make significant professional leaps" (p. 395). I feel I am on the right track for doing these things. I have chosen a respected facility, known for its teaching capabilities and with a Level 1 trauma center as my department of employment. I feel I have positioned myself for the greatest opportunity to build my knowledge, skills, and abilities.