SCOPE AND STANDARDS OF NURSING ADMINISTRATION PRACTICE 1
Scope and Standards of Nursing Administration Practice
Shelly M. Parker
Ferris State University
NUR 440
Abstract
The purpose of this paper is to evaluate and reflect on my own professional nursing roles and experiences to the American Nurses Association Scope and Standards of Nursing Administration Practice and The Code of Ethics for Nursing.I have provided examples and rationale to support how I meet many of the standards. For those standards I feel I currently do not meet, I have added a development plan to explain how I intend to reach the expected standards for nursing administration. The development plan contains goals and action plans with timelines.
American Nurses Association Scope and Standards of Nursing Administration Practice
The American Nurses Association (ANA) Scope and Standards of Nursing Administration Practice directs nurses on how to apply professional skills and responsibilities (ANA, 2009). A nurse administrator must be knowledgeable of the scopes and standards in order to efficiently support the nursing staff and ensure safe, quality care to patients. This paper will detail examples of personal and professional experiences that meet the standards achieved to this point in my nursing career. For those standards not met, a personal development plan has been developed to explain how I intend to meet and maintain those standards.
ANA Scope and Standards of Nursing Administration Practice
Standards of Professional Performance
Quality of Practice. “The nurse administrator systematically enhances the quality and effectiveness of nursing practice, nursing services administration, and the delivery of services” (ANA, 2009, p. 35). I have met the standard of quality of practice based on several reasons. My current position is a nursing home administrator for two hospital attached nursing homes. An example of innovation is a pigeon racing event. I have had to be creative in my role as a nursing home administrator to ensure the geriatric population receives a quality of life as many of the patients reside in the facility for an extended period. I routinely establish smart goals for the nursing activity department to think “out of the box” and come up with fun and exciting events to enhance the patient’s quality of care. One of the smart goals given to the activity department was a pigeon racing event. The event has become so popular that it occurs three times throughout the summer. The activity involves bringing in racing pigeons for the patients to hold and choose a bird to race. The activity provides tactile stimulation for all cognition levels. The winners receive a photograph and a prize for the event. The photographs are published in a quarterly newsletter. Another example is that I have initiated permanent assignments for staff and residents. The outcome of permanent assignments has improved satisfaction because the patients get to know their caregivers and feel more comfortable in knowing who will be caring for them on an ongoing basis. It also improved staff satisfaction because the work they do is more efficient and takes less time because they already know exactly what the patient wants. I also lead and drive the quality programs for both hospital attached rehab and nursing centers. Initiatives are obtained from many resources including feedback from patients during rounding, state surveys, satisfaction surveys and any trends identified in incident reports. An example of how I have incorporated new things I have learned to initiate change in the nursing practice is preventing potential burn injuries with patient’s drinking coffee. I work with a collaborative group consisting of nursing home administrators from other Spectrum Health nursing homes. Many facilities had received citations as a result of patients receiving burns while drinking coffee. I worked with the group to learn how fast a burn occurs on skin and at what temperatures. As a result, I worked with the group to develop an assessment to determine whether a resident has the ability to manage hot coffee safely. The assessment also includes interventions to use when the patient lacks the ability to manage drinking hot coffee safely. This has been a successful program and has reduced the incidents of patient burns with coffee. In my current position as a nursing home administrator, I am responsible for the development and implementation of policies. I also review and evaluate the policies on an annual basis. I am also responsible to lead all state and federal surveys and hold staff accountable to state and federal guidelines. I also write a plan of correction for all citations received during surveys. I provide education to all nursing staff on the plan of correction and complete compliance rounding. As the nursing home administrator, I am responsible to ensure compliance is sustained to prepare for a revisit by the surveyors to clear the facility of any citations received. I work closely with the Medical Director and the credentialing committees to ensure all individuals who are working within the facility and caring for patients in the facility meet the eligibility requirements. I also work with a legal team to ensure any contracts obtained for services such as dental; vision and podiatry also meet the qualifications to work with the geriatric population. I am also responsible to oversee criminal background and fingerprinting checks have been done on any staff as well as contractors working with any of the patient population. One of the areas that I have had to focus on in the last several years is the process of complaint investigations. Whenever a complaint is filed that alleges any type of abuse or neglect, I am required to report these events to the state department. My responsibility in conducting complaint investigations is not only to protect the patients, but also to protect the nursing staff and the facility. In doing this, I have always taught the nursing staff that it is important to always be honest and forthright in reporting allegations of abuse. Honesty and integrity are very important when conducting investigations. Ethically, it is important to be honest and always do the right thing. I currently maintain a registered nursing license and a nursing home administrator license for the state of Michigan. I obtained my nursing home administrator license after attending Michigan State University. I consistently attend courses to maintain my ceu’s to meet the requirements of my license. I have been audited once for each license so I have learned how important it is to keep education records up to date and complete.
Education. “The nurse administrator attends knowledge and competency that reflect the current practice” (ANA, 2009, p. 35). I believe I completely meet the standard for education. I am a member and participate in ongoing education through annual conventions hosted by Health Care Association of Michigan (HCAM). HCAM is a professional association that represents nursing homes across Michigan. The association provides educational opportunities that focus on care to the elderly. The association holds annual conferences and ongoing opportunities for nurses and nursing home administrators to obtain ceu’s. Opportunities are specifically designed to meet the educational needs to increase knowledge and professional issues for the nursing home administrators. I also attend Joint Provider conferences that are hosted by the Michigan Department of Licensing Bureau of Regulatory Affairs (LARA). Educational opportunities for nursing and care to the geriatric population are provided to both health care providers and state surveyors together.
Currently, I have one more semester at Ferris State University to complete the RN to BSN program. Once I am finished, I plan to continue to my education and pursue a master’s degree. Initially, when I began the RN to BSN program, I had no plans to continue on to obtain a master’s degree. However, as I have reflected throughout the RN to BSN program, I have decided it would be beneficial to me because I hope to finish my nursing career in the area of teaching and will need a master’s degree to reach that goal.
I also routinely seek opportunities to learn other areas important in my role as a nurse to develop and improve my skills. Even though I do not routinely provide direct care any longer as a nursing home administrator, I still maintain my nursing skills by attending skills day on an ongoing basis. I maintain my skills by helping the nurses whenever needed. For example, if a nurse is having difficulty starting an IV, I will jump in and start the IV. Recently, a new nurse was working and an order was received to insert a nasogastric tube. The nurse had never inserted a nasogastric tube, so I inserted the nasogastric tube and taught the nurse how to do the procedure. I also seek opportunities on a regular basis to improve my skills in budgeting. I meet with a financial person each month to review my budget. I also attend any in-services offered by the hospital to improve my budgeting skills. I share the information I learn in monthly staff meetings so staff are always aware of the monthly budget plan.
I consistently maintain my records in an area I can access easily and always have ready for an audit if needed. I also routinely access my Ferris records so I know what I still need to complete the BSN program and be ready for graduation in the summer of 2014. I routinely use journal articles, association updates and internet websites to review research findings and other important issues to increase my knowledge as a nursing home administrator. I also subscribe to MedScape nursing journal to stay updated on nursing issues. I also utilize the online library at Ferris State University for class assignments.
Professional Practice Evaluation. “The nurse administrator evaluates own nursing practice in relation to professional practice standard guidelines, relevant statutes, rules, and regulations” (ANA, 2009, p. 37). I believe I have met the standards of professional practice evaluation for many reasons. As a Nursing Home Administrator, I am responsible to ensure both of the facilities I work for are in substantial compliance to meet both state and federal regulations. I have also been involved in Joint Commission on Accreditation of Health Care Organizations (JCAHO) surveys. I have been responsible to review all the standards and compare to current policies and procedures and make changes to prepare for a survey. In addition, I have been responsible to roll out those changes to provide education to nursing staff. Part of that education has been regarding age specific care, cultural diversity and ethic competencies. I have also completed assigned papers in the RN to BSN program that relate to diversity. One of the papers I completed is on the LGBT population. I learned a great deal from writing that paper because the rural hospitals I have always worked for are not routinely exposed to this population.
I engage in self-evaluation on an ongoing basis. I have smart goals that have been developed by the organization as well as additional smart goals I have established for myself. These smart goals are reviewed on a monthly basis with an executive leader. I also meet with my direct supervisor quarterly and review my evaluation from last year and review where I am currently at and where I still need to continue to work to progress to meeting my goals. In these meetings, I receive both formal and informal feedback regarding my performance based on patient satisfaction scores, state survey results and comments from other nursing managers in the organization.
I also provide peer reviews on other nursing managers and department heads within the organization. I am responsible to complete annual evaluations on nursing, social services and activity staff. I have also worked with the nursing leadership group to develop definitions and expectations for performance evaluation scores. The goal of this project was to establish scoring consistency in evaluations. Once these definitions were developed, I rolled out the education to the nursing staff. I also hold monthly staff meetings with a standing agenda to discuss the evaluation process and do formal training. I also give informal feedback during rounding with patients and staff daily.
To meet the standard of interacting with other colleges, I meet every two weeks with other nursing managers to work on issues that are related to nursing practice, for example, medication administration policies, high risk low use equipment competencies and safety culture initiatives. I also round weekly with another manager from the hospital on other departments other than my own.
Collegiality. “The nurse administrator interacts with and contributes to the professional development of peers and colleagues” (ANA, 2009, p.38). I meet the requirements of this standard through various avenues. On a quarterly basis, I complete a formal power point presentation to the quality board consisting of a number of initiatives. I am responsible to present the information in a formal setting followed by a question and answering period. I also hold monthly staff meeting with a standing agenda to present findings on safety issues such as falls and complaint investigations. During my nursing career, I have also been an MDS Coordinator and still step in for care conferences as needed. I also share knowledge during rounds with staff. When I do find an issue during rounds, I present it as an informal education opportunity for staff. I also round with the Medical Director to talk with patients and families when there are concerns or require education on medical issues. In addition, I work with a collaborative board of nursing home administrators through monthly meetings. The nursing home administrators share knowledge on what was learned during conferences or from state surveys. One example of this is in a current state survey,the surveyors wanted to issue a citation because the facility does not have a physician that completes a hand on physical for new employees. The facility did not receive a citation, but this could be a potential citation in upcoming surveys. I shared this information with the other nursing home administrators at our monthly meeting. Through this discussion, legal counsel was consulted to take next steps. The other administrators also have the same process which is that a physician reviews a questionnaire completed by new employees, but does not complete a hands on physical. Meetings have been established in the near future to review legal recommendations. The nursing home administrator group will discuss and develop an action plan to determine next steps and establish a goal that meets the needs of all of the nursing homes.
I have a very good working relationship with my peers and colleagues. I work closely with the facility Medical Director to develop educational opportunities for the nursing staff. The Medical Director has physician assistant students on an ongoing basis. The Medical Director requires his physician assistant students to do one presentation over a medical diagnosis at the end of the rotation through the rehab and nursing centers. I coordinate this presentation into an educational opportunity that is available to all nursing staff to attend. I also tape the sessions so staff has the ability to watch at anytime.
I have attended safety culture training for Spectrum Health and promote safety in my daily interactions on the units. If a concern is voiced by the nursing staff regarding inappropriate communication from a physician, I share this information with the Medical Director. Together, we establish a plan to follow up with the physician because it is important that staff do not fear contacting a physician regarding a patient care issue. Together, the Medical Director and I follow up with the staff member to let them know we have addressed the issue. This was a concern especially at the one the facilities I currently manage. I scheduled a meeting to speak with the physician one on one to establish a better working environment. This has helped because the physician now comes to me directly with her concerns and issues are resolved much easier. I also routinely ask staff during my daily rounds if there are any concerns that need to be addressed and consistently follow up on those concerns to promote a healthy and supportive work environment.
An example of modeling interdisciplinary team work is when the Director of Physical therapy and I rolled out the expectation of an interdisciplinary team to meet daily to discuss all therapy patient care plans along with any safety items. This has been an effective process to deal with any patient care issues timely. I spot check these meetings by attending randomly. In addition, the team files daily reports that are sent to myself and the Director of Therapy services for review.
I have developed and assisted in many projects for staff to develop initiatives in the analytic process. An example is the RNC to CT process. The issue that was identified is that many CT appointments were being cancelled because the process was not completed correctly, delaying obtaining CT results for patients. In order to resolve this, mapping was used to lay out the current process and the problems identified. A new process was developed through mapping. Once the new process was completed, education was rolled out to the nursing staff. This has been successful in decreasing the amount of delayed CT exams.
Before I took the role of Nursing Home Administrator, I was the Director of Nursing. I have mentored the RN who took my place as the Director of Nursing. I continue to mentor the Director of Nurses. I also oversee social services and mentor two Social workers. As the Nursing Home Administrator, I participate in mentoring many staff in different disciplines. Regardless of what department a staff members works in, I am still responsible to ensure all health care services provided to the patients is appropriate. Therefore, I try to mentor and contribute to the development of all staff working in the department including therapy, nutrition services, maintenance and laboratory.