Professional Portfolio



Practice Transition Plan Paper BMolina AllenFerris State UniversityAuthor NoteThis paper was prepared for Nursing 324, Section VL1, taught by Professor Soles.Practice Transition PlanSince 1965 the American Nurses Association (ANA) has called for nurses to be baccalaureate degree prepared (Black, 2011). The American Nurses Credentialing Center (ANCC) recognizes nursing and healthcare excellence through the Magnet Recognition Program with recommendations for nursing leaders to hold at least a Bachelor’s Degree in Nursing (BSN) (ANCC, 2014). According to the ANA, “. . .every 10% increase in hospital staff nurses with a BSN results in a 5% reduction in mortality and failure to rescue,” (ANA, 2011). As more hospitals strive for and achieve Magnet status, the decision to continue my education was logical. Following are considerations as to how and why my professional standards and scope of practice will change in this journey and what the current leaders of nursing practice recommend during this phase. Professional IdentityIn my choice of nursing as a career, I chose a profession. As defined by Flexner, a profession must fit a certain criteria. Of Flexner’s characteristics that apply to my practice, I found the following to be most appropriate:" . . . Can be taught through a process of highly specialized professional education . . . Has a strong internal organization of members and a well-developed group consciousness . . . Is based on a body of knowledge that can be learned and is developed and refined through research" (as cited in Black, 2011, p. 53). While the paths to nursing are varied, my route started with an associate’s degree. This provided the fundamental skills and knowledge required for patient care; however, I realized an advanced degree would be beneficial to improve patient care, advance my career, and achieve a leadership role in my practice. In order for nurses to be respected, nursing must present itself as leaders in a collective unit that is cohesive and well-organized. While there are several associations affiliated with the nursing community, the ANA is at the forefront in defining and promoting nursing as a profession. According to White and Sullivan (2012):The American Nurses Association (ANA) successfully champions professional nursing excellence (1) by defining the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible and (2) by developing and implementing standards of practice and profession performance and a code of ethics (p. xiv). The scope of practice that is proposed by the ANA establishes a systematic process by which nurses are able to collaboratively and individually provide care and provides a guideline for exemplifying nursing as a profession. As stated by the author in the professionalism discussion board for Nurs 324:The ANA sets a bar that is high for recommendations of the accreditation, scope of practice, standards, and professional outlook . . . The ANA’s published Scope and Standards of Nursing were developed to be utilized by many states and organizations in developing laws to improve standard concurrence across the nation, thereby decreasing ambiguity and confusion as to the recommendations, roles, and responsibilities of nursing (White & O'Sullivan, 2012). These standards are published in many different media and are widely available to the public, students, and lawmakers (Allen, 2014).Nursing care is only effective if the trust of the public is earned and the political leaders of today have faith in the work of the nursing collective.Scope of PracticeANA’s Scope of Practice has defined nursing’s professional sphere under the establishment of Standards of Practice and Standards of Professional Performance. The nursing process provides the guidelines meant to enable nurses to provide optimal care within their designated capabilities. The ANA has published this scope of practice to decrease uncertainty amongst the healthcare community and public as to the dominion that nursing should ideally encompass. While this is a guideline, many states have adopted this as a part of their legislature that regulates nursing (White, 2012). The ANA provides the organizational unit that defines nursing as a profession. According to White (2012), Standards of Professional Practice, “. . . reflect the values and priorities of the profession and provide both a direction for professional nursing practice and a framework for the evaluation of this practice” (p. 24). Through this definition, standards serve as a model for safe, effective, and professional patient care.StandardsThe Standards of Practice which make up the nursing process include: assessment, diagnosis, outcome identification, planning, implementation, and evaluation (Ferris State University, 2010). Further, the Standards of Professional Practice enhance nursing as a profession through definition of what nursing encompasses and provides guidance as to how nurses may uphold and maintain the characteristics of a profession. While all the standards play important roles in nursing practice, currently the two in my practice that are critical to providing safe and appropriate care are assessment and intervention.AssessmentAssessment is the initial data collection and ongoing review of a patient’s systems (White, 2012). The ANA publishes, “Assessment is the foundation on which all health promotion, risk reduction for disease, prevention of illness and injury, care management, and organizational decision-making is built,” (White, 2012). While the unit that I work on is cardiac oriented, I ensure that I start each shift with a very thorough, head-to-toe assessment. Patients are multifaceted with a vast array of medical issues and potentialities. By gaining a baseline at the start of the shift, I feel I am better able to pick up on small changes prior to becoming larger medical complications. Interventions are evaluated based on the effects they have had from that baseline, thus enabling an applicable reference point. In order to determine whether interventions have been effective, it is necessary to re-assess the patient, evaluate the progress, and report pertinent findings to the healthcare team. It is also necessary to be wary of potential complications and safety concerns. An example of this would be a septic patient who is receiving fluid boluses. With these patients I frequently check lung sounds, anticipating the potential for an exacerbation of congestive heart failure. With this information I can formulate a diagnosis, plan an intervention, and progress to the next step of utmost importance, implementation.ImplementationPost assessment, diagnosis, and planning is implementation. Implementation may be defined as the process in the plan of care that is the action. The ANA further branches implementation into Coordination of Care and Health Teaching and Health Promotion. Nurses must use their critical thinking skills to choose and follow through with interventions working toward patient health (ANA, 2012). At novice level, advanced practice delegations through direct orders or protocols are initiated and may alleviate discomfort through repositioning and activities of daily living. Intermediate nurses moving forward recognize the actions needed to care for the patient’s immediate concerns as well as potential health problems, such as prevention of hospital acquired pneumonia or muscular atrophy with vented patients.As part of my practice, intervention is the doing. Without implementation, the healthcare team is at a standstill and the patient inert or declining. In critical care, the nursing process cycle can be very quick and repetitive. An example is titrating intravenous drips. Severe hypotension requires constant monitoring and frequent adjustments to vasopressors to maintain a consistency. Attempting to correlate a mean arterial pressure to an ordered parameter can be challenging. Coordination of care involves notifying the physicians of the patient’s current condition and response to interventions, while continuing to receive new orders and adjust care as ordered, within scope, or per protocol. Finding teachable moments for the patient and family can be combined with patient care. Explanations of treatments, responses, and the plan of care can be executed while the interventions are occurring. TransitionThe Quality and Safety Education for Nurses (QSEN) Initiative is designed to educate nurses in a way that promotes the safety of nurses and patients (AACN, 2012). Through continuous efforts to guide and enhance resources and the knowledge base of nursing schools, QSEN’s goal is to improve the education delivered on six core competencies: patient-centered care, evidence-based practice, safety, team work and collaboration, quality improvement, and informatics. These six competencies form the knowledge, skills, and attitude (KSA) benchmarks for developing and evaluating educational nursing programs. The KSA adapt through nursing education advancement (QSEN, 2014). In meeting KSA in my transition from ADN to BSN, I was challenged to consider the responsibility in fulfilling a new role in leadership. KnowledgeIn order to acquire knowledge, one must have education. The ANA reflects that, “The registered nurse attains knowledge and competence that reflect current nursing practice,” (ANA, 2010 as cited in Ferris State University). To be effective and validated, this education must be based on evidence-based practice. The baccalaureate prepared nurse has been exposed to statistics and research methodology, and is able to identify theory and practice that is scientifically derived. The QSEN Institute states the goal is to, “Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care,” (p.4).The ANA standard of Evidence-Based Practice and Research holds that registered nurses continually evaluate and ensure that their practice and given care is guided by current research that identifies a need for and promulgates improvement (White, 2012). Individually nurses may continue their education, read journals, stay up-to-date on current practice and procedures, integrate established theories into care, and take a leadership role in identifying and addressing dated, unfound practice within one’s employment. Through these actions nurses advance the profession of nursing to safer levels and provide a higher level of optimal care.SkillsThe ANA’s standard of Quality of Practice and QSEN’s Quality Improvement are interrelated. Per White, the Quality of Practice as defined by the ANA focuses on the RN’s role of having, “individual responsibility and accountability for quality healthcare,” (p.146). QSEN’s goals involve nurses being actively involved in recognizing patient outcomes in the populations served, participating in quality initiatives through employment, and seeking opportunities to locate discrepancies in care that deviate from best practice (QSEN Institute, 2014). The RN is called upon to take initiative in ensuring that practice is of the best quality and assumes the responsibility in achieving this through known evidence-based practice as well as contributing to current studies. Active participation by RN’s at the patient care level through implementation of practices, evaluation, and charting is a key factor in the ability of leaders to determine the effectiveness of quality improvement initiatives (White, 2012). Through joint efforts of all levels within the healthcare establishment exemplary quality of practice may be reached.Attitude As published in The Future of Nursing, the Institute of Medicine (2010) states, “As leaders, nurses must act as full partners in redesign efforts, be accountable for their own contributions to delivering high-quality care, and work collaboratively with leaders from other health professions,” (p. 3). Collaboration guides the healthcare team to awareness of the patient’s dynamic condition, needs, and continued progress in the plan of care. Collaboration must also occur with the patient, promoting autonomy and increased compliance (White, 2012).Confidently and efficiently working with the healthcare team, family, and other members relevant to a patient’s care is required to improve a patient’s probability of success. Becoming a motivated, pro-active part of a synergistic team is essential for nursing leaders. Transitioning to effective collaboration includes honing the ability to work with different personality types, conveying information across different sanctions of the healthcare team, while maintaining dignity and respect for the patient and the healthcare team. Self-evaluation must occur to determine appropriateness and meaningfulness of the collaboration’s strength (QSEN Institute, 2014). Significance and ConclusionWorking towards an ADN, the goal was how to best utilize the nursing process in providing patient care. In my year of practice since graduation, I have found the focus shift from being able to competently complete tasks and manage patient care to gaining a sense of how and why procedures and protocols affect my care and why they are in place to enhance patient safety. Critically thinking about how ANA Standards apply to my practice revealed that while the ADN was about the nursing process, the BSN encompasses a holistic and comprehensive view of treating the patient within a larger framework.As stated by Linda R. Cronenwett, PhD, RN, FAAN, “To be a good health professional into the future will mean knowing what constitutes good care (as it has in the past), but it will also mean knowing something about how the actual care delivered in one’s unit or clinic compares to expected or best practices . . . if there is a gap between good care and the results of care in one’s own system, being a good health professional will mean knowing what one can do to close that gap” (as cited in Black, 2011, p. 148). Through knowledge and continued education, the nursing profession will continue to expand their role and gain increased autonomy. As evidence-based practice continues to be integrated as the standard for healthcare, nurse’s roles have transformed from caring at the bedside to achieving positions as powerful and active leaders within the healthcare continuum. Nursing leaders, researchers, scientists, and political activists are making their voices heard and leading change to empower nurses with a goal of safer care. Education is the key in moving forward. As stated by Black (2011), “Leaders in nursing education today seek to transform the nursing workforce in a way that honors nursing’s social contract with the public, recognizing that education of nurses plays a critical role in their ability to achieve optimal outcomes for their patients, and to practice safely” (p. 132). My paradigm of ANA’s nursing process has broadened to include what my role is in the nursing profession currently and into the future. QSEN’s knowledge, skills, and attitudes provide the framework for a continual self-evaluation of the ability to uphold the ANA’s standards through my educational and professional journey. By taking an initiative to arm myself with knowledge, make my voice heard, and integrate research and best practices in my care, I will transition from capably going through the technical motions of complying with physician’s orders to being a proactive and contributing member of the nursing profession.ReferencesAmerican Association of College of Nurses. (2012). AACN extends national nurse faculty?development initiative with new funding from the Robert wood foundation. In News?releases. Retrieved from Nurses Credentialing Center. (2014). About ANCC. Retrieved from Nurses Association. (2011). Magnet: Good for nurses, good for patients. American Nurse Today, 7(1), 44.Black, B.P. (2011). Professional nursing: Concepts & challenges. St. Louis, MO: Saunders.Ferris State University. (2010). ANA standards of practice. In Standards of professional nursing practice. Retrieved from of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health.???????????Retrieved from ??????????? Nursing/Future%20of%20Nursing%202010%20Report%20Brief.pdfQSEN Institute. (2014). Pre-licensure KSAS. In Competencies. Retrieved from , K. M. & O’Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education. Silver Spring, MD: American Nurses Association. ................
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