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Standards of PracticeAshley YotkoisFerris State UniversityStandards of PracticeAssociates degree nurses who are participating in an Registered Nurse-Bachelors of Science in Nursing program come from numerous training and experience background as well as a different role within the institution they practice at. The purpose of this paper is, “to reflect on our everyday practice experiences and scope of practice in a critical way. Identification of your current scope of practice allows you to differentiate this from future practice as you transition into the BSN role,” (Soles, pp. 6, 2014).Professional IdentityNursing is considered a profession but is very unique in the sense that it has multiple entry level degrees. When transitioning from RN-BSN, it is important to know what makes nursing a profession and why we must maintain this status.Characteristics of a ProfessionOver the years, many intellectuals have defined and redefined what marks a certain career as a profession as well as attempting to make a distinction between and occupation and a profession. Profession is defined as, “an occupational group with a set of attitudes or behaviors, or both,” (Black, 2014). There have been multiple paradigms established over the years by sociologists that define a profession based on the characteristics that an individual will possess. Among these characteristics are autonomy, accountability, and the “desire to help others” or altruism (Black, 2014). Further characteristics that describe a profession are a specialized education within a college or university, improvement of skills redefined by evidence based practice, and beliefs or values system that is defined as a Code of Ethics by a professional organization that must be maintained (Black, 2014). All of these characteristics are applicable to nursing therefore placing nursing under the heading “profession”. Professional StatusMaintaining a professional status is very important for nursing as it not only mandates that nurses continue learning and updating their practice based on research but that are also are making decisions and providing care that is considered “best” for the patient. Professionalism of nurses also reinforces that care is being coordinated and collaborated by a nurse who can communicate the needs of the patient and family to the physicians and other members of the health care team, critically think, and anticipate needs or situations that may arise, is honest, and conducts his or herself in a socially and ethically acceptable manor. Scope of PracticeScope of practice defines what nurses can do as autonomous professionals and stay within the range of responsibilities they can perform. “The depth and breadth in which individual registered nurses engage in the total scope of nursing practice depends on their education, experience, role, and the population served,” (White & O’Sullivan, 2012). Scope of practice is comprised of six standards that make up the nursing process. These standards are assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. The nursing process is unique and based on an individual and can be used in clinical settings as well as education, research, and administration (White & O’Sullivan, 2012). AssessmentAssessment is the first standard in the nursing process. This is where nurses begin to gather information in order to begin forming a plan for care. “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 & O’Sullivan, 2012). This element in the nursing process changes continuously as will the planning for care. Initially, the nurse will assess a patient. She will develop goals with the patient and form a plan based on that assessment and goals with a multidisciplinary team. Implementation of the plan will help the patient to achieve optimal outcomes. During and after the implementation, nurses must re-assess the patient in order to evaluate how effective the care was.In the critical care unit, we will do a head to toe assessment. We then do a targeted assessment focusing in on an area of concern that is high priority. We must continuously assess and reassess our patients and the actions we have taken to correct the problem that has the highest priority. For example, for patients who have Coronary Artery Bypass Grafting a high priority issue that frequently occurs is hypotension. It is our interpretation of physical assessment, labs, and hemodynamics to decide the cause or causes of the hypotension. The data we gather from these components is what guides us in formulating our plan of care with nursing and other disciplines as well as prioritizing our interventions in order to meet our goals and ensure good outcomes. Obtaining my BSN will help with these assessment skills as it will enhance critical thinking therefore developing my nursing judgment and help me to better anticipate my patient’s needs based on their assessment. This will also promote better outcomes based on more specific long term and short term goals. PlanningPlanning is the fourth step in the nursing process. Planning is the documented course of care that is to be provided by the Registered Nurse to the patient to accomplish the desired outcomes that the patient and nursing collaborated on in previous steps of the nursing process (White & O’Sullivan, 2012). Assessment, diagnosis, and outcomes identification must be accurately completed in order to prepare an unique plan of care to elicit a superior outcome for the patient as an individual (White & O’Sullivan, 2012). The nurse and a multidisciplinary team will contribute to the plan of care in order to reach the goals set forth by the patient and nursing to improve the overall health of the patient. Prioritization and critical thinking will be crucial in organizing the plan as well as anticipating other possible issues that may arise, creating a list of interventions, and being able judge effectiveness of the interventions by a measurable outcome.In critical care, we must continuously reassess to decide what the priority for the patient is. We frequently use care pathways that include goals from a multidisciplinary standpoint as developing an entirely new plan of care for each patient would be extremely time consuming. From the previous example, patients who have had Coronary Artery Bypass Grafting have a specific set of orders with specific goals we must meet on every patient. However, we do not meet these goals in the same way with every patient. Some patients, for example, are hypotensive due to bleeding and others due to inflammatory response. Acidosis while on the ventilator could be because the patient has a pulmonary history or it is actually metabolic because the patient is developing some acute renal failure. Every patient is unique and so must our interventions in our plan of care to meet the goals for our patient. The plan of care is always changing as the patient’s condition improves or deteriorates. I believe that obtaining my BSN will assist in my planning of patient care as I will be more aware of practices and resources available to me for my patients and the research that provides evidence that these practices will provide better outcomes for them. I feel as though I will have a more extensive knowledge base to expand my judgment and critical thinking within my scope of practice to better plan for these patients on a short and long term basis.TransitionThe ADN will learn and begin incorporating standard one through six into their nursing practice. The nursing process will become second nature and will be automatic versus having to think through it. When transitioning into the role of a BSN, standards 7 through 16 are learned and must be emphasized through nursing practice. “All nurses need to acquire knowledge, skills, and attitudes that lead to competency in the area identified by QSEN: patient-centered care; collaboration; team-based, evidence-based practice; quality improvement and safety; and informatics” (White & O’Sullivan, 2012). Establishing and implementing nursing standards of care within core curriculums nationally will assist in achieving the goal of BSN prepared nurses with professional knowledge, skills and attitudes that are reflected in their practice.Incorporating QSEN into your nursing practice, attitude, and skills will help propel your practice to the next level. Evidence based practice (EBP) will help advance your practice by incorporating best practice and research in order to provide up to date and competent care. Patient and family centered care looks at more than just acute care of a patient, but also examines the patient and their family in the community and how they need to be cared for and what resources they will need once they leave the hospital. Collaboration is a skill that is necessary to make sure that the patient in their entirety is cared for and the best possible outcomes will be achieved. By collaborating with all the disciplines and incorporating EBP, the patient outcomes and patient’s perception will increase. Safety and ensuring safety is a priority within not only your department for staff and patients is important but also assessing safety throughout the facility and within the community where our patients live.KnowledgeEvidence-based practice and research is an extremely important part of nursing as a dynamic profession that relies on on-going education to improve patient care and outcomes. “Focusing on evidence of effective interventions is a good means of preventing one’s practice from deteriorating into routine or traditional care based on what has always been done without concern’s for advances in care,” (Black, 2014). The professional nurse understands how to find reliable and up to date research. This nurse also understands the importance of the best evidence from nursing research and the integration of this into nursing practice to improve patient outcomes. Not only does the BSN prepared nurse seek out evidence for updating practice but helps to educate and help others implement this within their own practice. The ADN nurse may not understand the importance of best evidence and research on one’s practice and continue to use basic, outdated practices. It is extremely important for all nurses, BSN prepared or not, to continually update their practice as healthcare, “constantly evolves and responds to the emerging health and illness needs of individuals, families, communities, and populations; to the rapid advances in science and technology; and to the continual changes in healthcare systems and policies,” (White & O’Sullivan, 2012). Healthcare is dynamic and nurses need to be less reluctant to change. Improving skills and knowledge with research and evidence will improve the care of our patients leading to improved outcomes and increased patient satisfaction. SkillsWhen considering skills, an ADN nurse thinks of tasks such as starting an IV or putting in a nasogastric tube. The BSN prepared nurse considers communication an imperative skill for improving practice. Communication is probably one of the most important skills that can be mastered by any nurse. The BSN prepared nurse understands that assertive communication is important to show and gain respect, portray confidence, encourage open and honest messages between a sender and a receiver. “Research has shown that effective communication is essential to safe, quality patient care and to healthy work environments that lead to nurse satisfaction and staff retention (White & O’Sullivan , 2012). In order to have successful communication between nurse and patient or anyone within the healthcare team, there are certain terms that need to be met which include feedback, appropriateness, efficiency, and flexibility (Black, 2014). This means we need to constantly uphold good communication between team members in order to provide the best care to our patients.Poor communication can wind up hurting the patient as it hinders trust and ultimately, patient care. When anyone who is part of the healthcare team does not treat the patient individually, is judgmental, is unclear about information provided regarding care, or does not listen to what the patient is saying, they can cause these communication breakdowns and important information can be missed (Black, 2014). The professional nurse will use effective communication or recognize ineffective communication and attempt a different to resolve the miscommunication in order to encourage better patient outcomes.AttitudeBeing a registered nurse requires that nurse is professional and more importantly, is a leader. “Leadership is a professional responsibility shared by all registered nurses (RNs) at all levels of practice in all settings (White & O’Sullivan, 2012). A leader will use nursing judgment and critical thinking skills as well as be able to guide fellow nurses. A leader will be able to communicate their message without condescension or malice and motivate people to achieve a common goal. This nurse understands the importance of all practice standards and incorporates them into their care.Leadership is of great importance in the nursing profession as healthcare is changing constantly. A leader will be very flexible and easily make appropriate changes to their practice to be able to provide a higher level of care as well as set an example for other nurses as well as members of other departments and their patients. Leaders take pride in what they do and encourage others to also lead by example. Nurses who accept the responsibility of leadership in education, quality, community, administration, informatics and research will preserve and modernize the future of the profession of nursing. The attitudes that RN’s in leadership positions have are always professional and often provide the best care to their patients, use resources in and out of the hospital as needed by their patients, and are diligent in maintaining a nonjudgmental disposition while providing care. SignificanceA “ideal” BSN prepared nurse is accountable, altruistic, honest and knowledgeable in their profession. As nurses have a greater understanding of all the standards of practice and implement them within their scope of practice according to the code of ethics as well as having knowledge in sciences of technology, philosophy, economics and psychology (White & O’Sullivan). As nurses are considered one of the most-trusted professions, their position “imposes a responsibility to provide the very best health care, which requires well-educated, clinically astute nurses and a professional association composed of those nurses, which establishes a code of ethics, standards of care and practice, educational and practice requirements, and policies that govern the profession,” (White & O’Sullivan).Advancements in technology and healthcare play a huge role in the nursing profession. This is why it is imperative that nurses continuously update practices based on best evidence from nursing research. Continuously questioning nursing practices will advance critical thinking skills and nursing judgment at all levels of nursing from graduate to administrator. Encouraging evidence based practice not only in nursing but in all areas of health care will provide the best practices for our patients and healthcare organization on a multifaceted level from various disciplines.Being a role model and educator within nursing is just as important as collaborating on a patient’s plan of care. A BSN prepared nurse understands why this is important and strives for excellence in the delivery of care, continuing education, attitude, and skills. Striving to maintain an courteous attitude, continuously developing knowledge, and maintaining collegial communication preserves nursing as a profession and the standards of care guide us in our profession.ReferencesAmerican Nurses Association [ANA]. (2012). The Essential Guide to Nursing Practice. K.M. White and A. O’Sullivan (Eds). Silver Springs: .Black, B. P. (2014). Nursing’s pathway to professionalism. Professional Nursing; Concepts and Challenges (7th ed., pp. 55). St. Louis: Elsevier.Soles, R. (2014). NURS 324: Transition into professional practice [course syllabus]. Retrieved from Ferris State University My FSU course page: /portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_11486_1%26url%3Durse page: ................
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