NURSING PROFESSION 1
Nursing Profession
Alicia Troup, R.N.
Ferris State University
Abstract
Nursing has not always been reflected as an admirable career or let alone a profession, at least, was not the case years ago. When people began to change their attitude and acceptance considering nursing as a profession has transpired. The nursing profession has all of the characteristics and standards to prove that it meets the criteria to be considered a profession. Nurses who continue to advance in their nursing education and have respect and autonomy in their practice can lead the future of the direction of the nurse’s role in the healthcare industry.
Nursing Profession
The nursing profession and the definition of nursing has evolved throughout the years. Florence Nightingale was one of the first to attempt a written definition of nursing and also acknowledged the complexities of nursing. Florence Nightingale wrote, “what nursing has to do … is to put the patient in the best condition for nature to act upon him” (Black, B.P.,2014, p.115). This definition has set a foundation of the need to define nursing. From there, a vast number of definitions have developed about nursing and the profession it has become. The purpose of this paper is to explore and evaluate a couple of standards in the scope of practice along with the professional identity of a Bachelor of Science nurse (BSN) that can enhance ones nursing practice.
Professional Identity
When identifying nursing, in order to be considered a profession, the differential between whether or not nursing was an occupation or profession had to be known. Nursing as a profession has been reviewed and examined numerous times since the Flexner Report came out in 1910. Five years later Flexner made available a list of criteria which establishes how to determine if a career could be considered a profession. According to Flexner’s criteria, nursing meets these six characteristics; 1) the profession is academic and requires the individual to be accountable for their choices and actions, 2) the education from nursing school is the foundation of one’s practice and is refined through continued research and hands-on experience, 3) nursing is practical and theoretical, 4) the nursing knowledge has been obtained from the advanced education from specialized educators, 5) nursing as a profession has a solid group of professionals that collaborate in their everyday practice and are constantly in tune with one another, and 6) a driven factor in nursing is the want to care for another and have their best interest at hand (Black B.P., 2014, p.53). By nurses using these competencies in their practice, they are outwardly expressing many of the characteristics of the nursing profession.
The Wheel of Professionalism in nursing has eight spokes that surround the middle of the wheel that “…represents the essential foundation of nursing education in an institution of higher learning” for which nurses need to follow (Black, 2014, p.58).
According to Black, B.P. (2014),
Each of the eight spokes represents other behaviors deemed necessary in maintaining or increasing nurses’ professionalism. They are competence and continuing education; adherence to the code of ethics; participation in the primary and referent professional organization, i.e., ANA and state constituent member association; publication and communication; orientation toward community services; theory and research development and utilization; and self-regulation and autonomy. (p. 58)
Professionalism is one of the most important qualities that a nurse should have a high standard for in their practice. A nurse that is professional and has the behaviors of professionalism will be able to provide great patient care and be a ideal team player in the health careteam.
Scope of Practice
Building upon the characteristics that make nursing a profession, the nursing scope of practice establishes what is expected of an RN. The scope of practice allows a nurse to perform certain tasks, procedures, and actions that are allowed under their licensure. The American Nurses Association (ANA), describes and distributes the accountabilities linked with the Standards of Professional Nursing Practice and nursing’s scope of practice. According to White, K.M., (2012), nurses are responsible for their education, skills, and conduct to themselves, to the organization, to monitoring and legal entities, to the profession, to the patient’s they treat, and to civilization (p. 24). Not only does the ANA provide nursing with a scope of practice but the National Council of State Boards of Nursing (NCSBN)stipulates laws that protect the public's welfare by guaranteeing safe practice of nursing. All states in the U.S. and territories have passed a nurse practice act (NPA). "All NPAs include: authority, power and composition of a board of nursing, education program standards, standards and scope of nursing practice, types of titles and licenses, requirements for licensure, grounds for disciplinary action, other violations and possible remedies" (NCSBN, 2016, What are the laws related to nursing). A nurse’s duty is to provide the best and safest care for all patients and one way this can be monitored is having the NPA. There needs to balance and order in the nursing profession and that is achieved by having laws and regulations in place. That being said it is crucial for us, as nurses, to uphold the best judgments when caring for patients because we are liable for what is done under our nursing license. It is anurses duty to keep up to date on the best evidence practice and continue to do their CEU's. It is a great privilege to have a license and it is very important to abide by the laws of nursing. If a nurse does not use good judgment or provide safe care, their license can be revoked or suspended. That then is where the NPA’snice to have, so there is a process to be had and followed. With the combination of what the ANA and NCSBN provides the nursing profession, the individual nurse can take actions into their hands and have aguideline to provide the best patient care in their practice.
The first six standards of nursing practice established by ANA are the following: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. These standards are what every registered nurse must do in their nursing practice. These standards are being taught in every nursing school, regardless if it was acquired through an accredited diploma program, ADN, or BSN program. Nurses receive report from fellow nurses or health care team members. From there, nurses with the acquired information can perform assessments on all of their patients. While Nurses are assessing the patient, they need to look at the whole picture not just the person and their diagnosis. Being able to view and treat the patient as a whole rather than one defining factor is the core of the nursingprofession. To add to the collecting of data from the electronic health record and assessment findings, a Nurse is looking at the diagnosis to collaborate and implement a plan for their patient. Nurses asses what outcomes need to be achieved. In this plan, nurses will need to educate and address any issues or any misunderstandings the patient or family has about their treatment plan or diagnosis. Throughout the nurse's practice, they are continually evaluating the whole treatment plan set for their patients. Nurses need to make it their priority to keep their patients safe and advocate for them when needed.
Nursing is so versatile that it can have endless opportunities for individuals to grow into their profession, whether obtaining a BSN, nurse certification in a specialty, a Master’s or Doctor’s prepared nurse, the scope of practice expanses and the nursing standards 7-16 are supplementary to the organization of nursing. Nursing: Scope and Standards of Practice, 2nd Edition (ANA, 2010b), provides 16 standards that serve as guidelines for how nursing profession can practice their role as a professional.
Standard 7 Ethics
According to White, K.M. and O’Sullivan, A. (2012),
The Code of Ethics for Nurses, which has evolved over time, is a dynamic document that is revised periodically to remain current with advances in the profession and in the healthcare environment. The Code reflects the profession’s central and enduring values, which include service to and duties toward those whom we care, as well as to ourselves. (p. 113)
Every action and decision nurses make directly relates to the core values of nursing. Remembering to act with integrity and stay true to the ethics that nursing is based on is a crucial part of acting with professionalism and with the best intentions of the patient.The ability to prioritize and advocate the needs of all age groups spanning all different ethnicities and backgrounds while keeping in mind theindividuality of the patient and theirfamilynecessities is key. Proving standardized, unbiased care and education through practice for the community will enhance the quality of life for the patients in need. There are many factors that come into play in order toeffectivelycontribute the best quality of care to people across many different walks of life.Factors include gender, income, race, religion, culture, a degree of medical need,and personalbeliefs. All these factors need to be evaluated for any ethical dilemmas or decisions that need to be made in order to provide ethical care to patients.
Standard 9 Evidence-based Practice and Research
Evidence-based practice (EBP) has been the brick and mortar of the nursing practice. As a practicing nurse, keeping up with current standards of patient care and safety is the cornerstone. EBP is defined as a method to supply the health care that “integrates the best evidence from [research] studies and patient care data with clinician expertise and patient preferences and values (Black, B.P., 2014, p. 227). Incorporating currentresearch about the best evidence-based care is crucial to provide the safest patient care. As a nurse, it is one’sresponsibilityto keep up on their education and be able tointegrate safe practices in taking care of patients. It also involves continually learning new skills and keeping up with medical equipment needed in order to care for the patients. Researching is a huge part of nursing, and learningis what comes from research. As a nurse, new studies and evidence-based journals are constantly evolving. Nurses are in fact always responsible for learningnew protocols and how to take care of a person who might require specialized care.Patients expect to feel like they are getting the highest quality of care while they are in need. For that to be given, the health care team needs to use current evidence to support the best treatment options.
Baccalaureate Role
The Baccalaureate prepared nurse has extensive training in clinical, scientific, decision-making, and humanistic skills, including preparation in community health, patient education, and nursing management and leadership skills (Black, B.P., 2014, pp. 136-141). The baccalaureate prepared nurse's scope of practice broadens the parameters on how a nurse can be engaged in their nursing practice. The amplification of standards sets up the nurse in a position where one can improve upon development in the BSN place of employment, promote leadership and remain ethically in practice, collaborate and communicate with health care team along with patients and their families, and incorporate evidence-based practice and quality of practice. The Quality and Safety Education for Nurses (QSEN) provides six competencies that can be intergraded into the nursing profession and can give the tools or avenue to be able to be proficient in one’s nursing practice. “All nurses need to acquire knowledge, skills, and attitudes that lead to competency in the areas identified by QSEN: patient-centered care; collaboration; team-based, evidence-based practice; quality improvement and safety; and informatics” (Brown, P., 2012, p.179). According to Sherwood, G., & Zomorodi, M., (2014), patient–centered care can be met by acknowledging the patient or power of attorney in charge of their health and collaborator in providing patient-centered care with all their needs in mind. Teamwork and collaboration are working side-by-side with nursing and other health personnel, clarifying responsibilities and contributing to decision-making to accomplish quality patient care. Evidence-based practice provides the most up-to-date evidence-based practices with nursing skills. Quality improvement is applying data to examine the outcomes of care processes and use strategies to change and improve patient care and safety. Safety can be accomplished by decreasing the risk of harm to patients and health professionals by using procedure effectiveness and individual responsibility. Informatics can be used in nursing by utilizing evidence and technology to communicate, operate skills and expertise, diminish error, and aid in decision-making (p. 18). By nurses using these competencies in their practice, they are exceeding the knowledge, skills and attitude needed in the nursing profession.
Knowledge
A Baccalaureate prepared nurse has an increased understanding of anatomy and physiology as well as the other required advance classes that are meant to build upon the foundational ADN or diploma knowledge base. It is essential for nurses to broaden their knowledge and understand other areas of the health care system to be able to advocate for their patients and as well as individual needs of the community. “The education Standard of Professional Performance describes the professional obligation to acquire and maintain the knowledge and competencies necessary for current nursing practice” (ANA, 2010a). By elaborating on a present knowledge base, the nurse can offer her patient, excellent evidence-based practice care as an addition to the exceptional RN skill set.
Skills
The progressive skills developed by extended education are endless. Whether the skills are learned as theoretical or perceptible, the nurse has added to an already wide-ranging and all-encompassing skill set that was acquired with the RN acquisition. “Nurses commit to their profession by utilizing their skills, knowledge, and abilities to act as visionaries, promoting safe practice environments, and supporting resourceful, accessible, and cost-effective delivery of health care to serve the ever-changing needs of the population” (ANA, 2010b).The BSN prepared nurse should take on the role of a resource person and evaluate existing skill sets, procedures and policies in the workplace to improve upon outdated and non-evidence-based practices.
Attitude
The attitude expected by a BSN prepared nurse should be that of a mentor. Leadership positions and resource guides are roles in which a BSN nurse can merge into from her existing RN position. Assisting peers and directing novice nurses in a self-effacing way promotes a trusting mentoring relationship and one of approachability. The BSN nurse “recognizes the impact of personal attitudes, values, and beliefs” (ANA, 2010b). The professional nurse not only represents herself but as always the entire medical community. Therefore, the BSN nurse needs to evaluate their attitude continually and make sure that is reflective in a positive manner.
Significance and Conclusion
The BSN prepared nurse can evaluate their practice by self-assessment as getting feedback from patients, patients family, colleagues, management, and nursing standards. While doing so, the BSN can look for ways to promote quality and safety in their nursing practice. “Nurses use quality improvement tools and informatics to seek evidence and measure care outcomes, as well as benchmark data to assess current practice” (Sherwood, G., and Zomorodi, M.,2014, p.19). A mindfulness of improving outdated systems and overall compliance in healthcare needs to be addressed in all nurses nursing practice. A culture of safety according to Sherwood, G., and Zomorodi, M. (2014), “en- courages asking how one’s actions affect patient risk, where the next error is likely to occur, and how to prevent near misses, and there is a reporting system for collecting infor-mation on adverse and sentinel events” (p. 19). Leadership plays a vital role in a nurse’s practice. Having leadership skills and promoting leadership in the nursing profession is a great start to lead to a better health care system. A nurse’s role in their nursing practice is more than educating and treating patients, but their every action needs to stay true to the standards, ethics, and criteria of the nursing profession.
References
American Nurses Association (ANA). (2010b). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org
Black, B.P. (2014). Professional Nursing: Concepts and challenges (7th ed.). St. Louis,
Missouri: Saunders.
National Council of State Boards of Nursing(NCSBN) (2016). Nurse practice act, rules & regulations. Retrieved from
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefining nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15- 22. doi: 10.1097/NNA.0000000000000124
White, K.M. & O’Sullivan, A. (2012). The essential guide to nursing practice. Washington D.C.: Author