Ensuring that nurses work according to the philosophical underpinnings of their profession is crucial in achieving quality and nursing job satisfaction. Professional nursing means working with others to provide patient care, being able to manage complex tasks, and utilizing available evidence to influence positive health outcomes (Tsai, 2021). I remember when I was working in the pediatric unit, we had the challenge of communicating patient information among nursing teams. There was a lack of clear communication means for incoming and outgoing staff leading to gaps in care delivery. To address this problem, I proposed the utilization of bedside shift reporting together with the integration of the SBAR technique during the communication of information (Competency #11). After a few weeks, the implementation of these strategies improved care delivery and minimized errors through effective communication.
Nurses are accountable to monitor and maintain their fitness to practice to ensure quality and safety during care delivery. Fitness to practice entails having the necessary physical and mental health to provide compassionate, safe, and competent care to patients. For example, when I was working in the medical unit, I noticed a colleague attempting to move an elderly patient by themselves. The care plan had stated that two nurses were allowed to move the patient to minimize injury and reduce pain. I informed the nurse that the technique used was not appropriate and offered help to ensure moving the patient caused no discomfort (Competency #15). I later informed my colleague to take a few hours to practice moving and handling techniques to avoid harm to patients in the future.
Maintaining current knowledge about trends and issues in nursing is important for all nurses (Tsai, 2021). One of the issues affecting nursing practice today is workplace bullying from fellow nurses or doctors, especially for junior staff. For example, when I was working in the pediatric unit, I observed a senior doctor who always unfairly treated nurses for doing subpar jobs in front of patients. These actions made it difficult to provide care and the majority of staff feared working with the doctor because of this behavior. I understood that workplace bullying contributes to a poor nurse work environment and affected the quality of care delivery (Competency #16). To address this challenge, I reported the observation to the unit manager and asked investigation into the issue to ensure the root cause was addressed.
An allegation of professional misconduct can be devastating not only in the line of the nursing profession but also in personal life stands. Nurses should practice according to the code of ethics and professional standards (Haddad & Geiger, 2021). For example, I came across two nurses discussing confidential patient information in the cafeteria. Fortunately, there were no outsiders who could have heard the information, but still, they acted unprofessionally by breaching patient confidentiality. Understanding the weight of this problem, I called the two and explained how the breach of patient confidentiality was unlawful and could cause a problem for the hospital and their career (Competency #17). The two were sorry about the situation and acknowledged it was wrong to discuss patient information in the manner observed.
Adverse events, errors, and near misses are negative outcomes during care delivery that frequently cause harm to patients. The nurse should work to recognize these adverse outcomes and act in a manner that poses minimal risk to patients. For example, I was once charged with conducting hourly rounding in the ward to identify patients at risk for falls and make necessary interventions. However, the day was busy and failure to conduct the rounding led to a patient falling from the bed. Although the fall did not cause significant injury, I had to fill the incident report and report the case to the nurse manager (Competency #18). I was asked to write a report about the circumstances leading to the adverse outcome and how it could be prevented in the future.
As healthcare professionals, nurses strive to inspire confidence in their patients by acting in their best interest. While working together with patients and families, nurses should maintain professional boundaries and avoid developing personal relationships (Haddad & Geiger, 2021). For example, when I was working in the pediatric unit, there was this family that could bring gifts to nurses. It was later noticed that they demanded special attention for their child. I realized that it was unacceptable to cross professional boundaries and accepting gifts for staff encouraged the family to think that they could demand special care (Competency #20). I explained to the family about professional boundary violations for reasons that were not therapeutic and their consequences.
The provision of safe and culturally sensitive care to patients is among the areas stressed by the Truth and Reconciliation Commission of Canada(TRC). The nurse is required to collaborate with other healthcare providers and use a family-centered approach to ensure culturally safe client care (Haddad & Geiger, 2021). For example, When I was working in the pediatric ward, I took care of a 6-year-old child that had not received any immunizations. During history taking, I realized that the mother had 6 months child who was also not immunized because of their traditional beliefs. Realizing the danger of this practice, I called upon the services of an indigenous nurse to share cultural beliefs and help advise the family on the best course of action (Competency #24). After comprehensive education, the family accepted to visit the nearest health center to begin appropriate immunizations for their children.
The equitable distribution of healthcare resources is a known healthcare challenge for administrators and policymakers. Failure to address this problem can lead to wasting health resources and impose extra costs on patients. For example, there was a time when we had a shortage of nurses in the pediatric unit and it caused a lot of problems for patients and available nurses. We had to work overtime to cover the shortage and the quality of care decreased because of burnout. Together with other unit members, we advocated for the recruitment of more nurses to the unit to cover the shortage (Competency #26). Before recruitment could be done, the nursing services manager brought in a few nurses who had previously worked in pediatrics to help with covering the shortage.
Nurses can advocate for patients in many aspects including better treatment, legal options, and payment solutions. For example, there was a time when we had a high number of hospital readmissions upon discharge. I realized that there was a minimal follow-up of patients upon discharge and this greatly contributed to the challenge. To address the problem, I communicated to the case managers about ensuring patients received appropriate attention at home (Competency #27). This intervention proved to be effective in our unit and it was recommended across all hospital departments.
The practice of nursing is a right granted by a state to protect patients and to ensure nurses provide competent and safe care. The College of Nurses of Ontario (CNO) is the regulating body for all nurses in Canada and sets laws governing the delivery of patient care by nurses of all caliber. For example, when I was working in the pediatric unit, I encountered a situation where a patient required the initiation of IV fluids. However, there was no order for this intervention and I understood that I had no authority to initiate venipuncture to establish peripheral venous access and maintain patency (Competency, #30). I worked in the interest of the patient by informing the physician about the patient’s condition and after authorization, I proceeded with the intervention.
Safety concerns are one of the reasons why nurses might fail to follow orders during care delivery. A professional nurse should know when to question orders and report appropriately when violations are made. For example, there was a time when I did not agree with the doctor’s order to obtain verbal consent for a procedure instead of written consent as per the hospital guidelines. I realized that this order was not appropriate and the doctor was only trying to use shortcuts to save time (Competency #31). I declined this order, took my time to explain the procedure to the patient, and ensured a signed consent form was used.
Nurses are accountable for reporting to appropriate authorities when actions or behavior towards a patient by colleagues or other members are abusive (Tsai, 2021). Abuse to the patient may be physical, verbal, emotional, sexual, financial, or take the form of neglect. For example, there was a colleague who had problems with establishing rapport and providing good care to patients. She always responded rudely to patients and I realized that her actions affected good relationships between patients and nurses in the unit. To address this challenge, I reported the behavior to the charge nurse and requested further action to ensure patients were treated well (Competency #32). After a series of talks and undergoing training on effective communication, the nurse was able to relate well with patients.
Foundations of Practice
A comprehensive health assessment involves taking a history, general survey, and complete physical examination. The assessment gives the provider insight into the patient’s condition through observed and reported information. For example, in the pediatric unit, taking comprehensive developmental history is important during admission. Earlier on I described an encounter with a 6-year-old child who was not immunized. Further history taking revealed cultural concerns that prevented the child from getting the required immunizations (Competency, #37). I was able to formulate a plan for the patient and the family based on this history including an appropriate referral.
Nursing research develops knowledge about the health of patients and strategies that can be used to enhance positive patient outcomes. For example, we had a problem with increased hospital readmissions in the pediatric unit. I actively engaged in research and realized that health education upon discharge was not comprehensive in the ward. To address this challenge I proposed the use of the patient teach-back strategy upon education to ensure all information was understood (Competency #39). The application of this strategy addressed a few gaps in patient education and demonstrated improvement in patient readmission status in the unit.
The utilization of evidence-based practice in nursing is a strategy that has improved the quality of care and patient safety today. It is the role of the nurse to utilize evidence from various sources to inform patient care (Tsai, 2021). For example, there was a time we had a challenge in communicating patient data among nurses during shift handover. The majority of the staff used shortcuts and this made it difficult to present relevant patient information. I consulted with the nurse educator on the most appropriate strategy that could be used to address the challenge. I also utilized evidence from peer-reviewed journals and realized that the use of bedside shift reporting was supported to be the best means of communicating patient data (Competency #40). The application of this strategy led to improved communication of patient information during a shift change in the unit.
Health assessment is a strategy that allows nurses and other healthcare providers to get a glimpse of the patient’s health before interventions are made (Ajibade, 2021). RPN is supposed to assess patients and report findings to other providers for interventions to be made. For example, when I was working in the pediatric unit, I used to assess patients by taking history, vital signs, and physical examination and reporting findings to the assigned registered nurse (Competency #41). Reporting assessment findings helped me to identify areas of weakness and those that could be improved to ensure adequate data was collected to guide healthcare decisions.
Developing a care plan for patients is a crucial step in providing nursing care. Care plans dictate the types of interventions based on individual patient assessments and provide reference points for determining the effectiveness of interventions made (Ajibade, 2021). For example, when I was working in the pediatric unit, I collaborated with colleagues to formulate care plans for sick patients. The care plans incorporated aspects of medication administration, fluid intake, and care for families (Competency #44). I observed that the care plans provided a daily guide for nursing interventions and formed a reference point for the effectiveness of interventions made by nursing care teams.
Nursing interventions are actions the nurse takes to implement their patient care plan and include things like procedures, teaching patients, and administering treatment. For example, when I was working in the pediatric unit, I managed a child admitted due to pneumonia. On assessment, I observed that the patient’s condition was not stable for the continuation of oral feeds. The patient was restless and irritable putting him at risk for aspiration if oral intake was continued. I informed the attending physician and eventually, oral intake was discontinued and IV fluids commenced (Competency #45).
Prioritization of patient care is one of the qualities that professional nurses should possess. A competent nurse should know what interventions to put first to prevent suffering or harm to the patient (Tsai, 2021). For example, when we had a shortage of staff in our unit, we prioritized care according to the patient’s condition. We always began in the morning by dealing with category A and B patients before attending to those that were stable. Things like the preparation of patients for theatre and administration of medication were given priority before procedures like laboratory investigations. Tasks like discharge planning and patient education came last after performing the most important tasks in the unit (Competency #46).
Health literacy is the degree to which patients or individuals possess the ability to obtain, process, and understand basic health information. The nurse should assess the patient’s level of understanding and use the most appropriate approach during education. For example, when I was working in the pediatric unit, I was the task of educating mothers on infection prevention upon discharge. I realized that majority of the mothers could not understand things like routine wound care and some basic hand hygiene practices. To effectively educate these mothers, I used to do education using videos and pamphlets this strategy ensured that mothers observed what was being taught and had a point of reference for what was taught in the ward while at home (Competency #47).
Providing health education to patients also requires assessment of their understanding and retention of information (Ajibade, 2021). For example, there was a time when the majority of children admitted to the pediatric unit had gastroenteritis. I was tasked with educating mothers about hygiene, the care of infants, and other aspects of nutrition. I organized health education sessions where I educated mothers about hand hygiene, keeping children away from dirt, washing hands with soap before bottle or breastfeeding, and rotavirus vaccination. I used the teach-back method to confirm the understanding of mothers about what was taught and other healthy habits (Competency #48). To ensure parents had adequate material for reference, I collaborated with the nurse educator and printed pamphlets that identified common practices that increased children to infection (Competency #49). After completion of the education sessions, I used the follow-up method to track the patient’s progress and new cases of the disease in the unit. Within a month, the number of cases reduced and we did not have any readmissions due to the same condition in the unit (Competency #50).
Patient safety is a healthcare discipline that has been emphasized as a result of increased errors and adverse events. Nurses should apply safety principles like risk management, infection control, patient education, and preventive measures during care delivery (Haddad & Geiger, 2021). For example, when I was working in the pediatric unit, I used to prioritize health education for mothers regarding important aspects like nutrition to promote recovery. In other instances, hand hygiene was stressed to minimize the transfer of pathogens to patients (Competency #51).
Quality improvement and risk management are important aspects that ensure the well-being of patients and staff in healthcare organizations. The identification of threats that could harm patients, staff, and anyone else is an important step in promoting health (Ajibade, 2021). For example, there was a time when infection prevention and waste disposal were a challenge in the pediatric ward. I observed that most staff did not segregate wastes appropriately and this left subordinate staff at high risk of getting an infection. I consulted the nurse educator and organized an educational program for all nurses regarding waste disposal and segregation (Competency #52). The education session helped most nurses to dispose of wastes in the appropriate bins thus minimizing the risk of infection and harm to other staff.
Evaluation of outcomes is the fifth step of the nursing process that indicates whether interventions made were effective (Ajibade, 2021). Outcome evaluation helps nurses in recommending interventions and making adjustments to interventions made. For example, when I was working in the pediatric unit, I managed a 7-year-old patient with burns. The patient required dressing after every two days for three weeks until the wound area was clean for skin grafting. After two weeks, I observed that alternate day wound dressing was not effective and it could take more time before the wound was ready for grafting (Competency #53). I consulted with the physician and recommended daily dressing and wound exposure therapy for two weeks. This new strategy turned out to be effective and the patient was ready for skin grafting (Competency #54).
Clinical decision-making is a complex process that always involves processing information, evaluating evidence, and application of relevant knowledge and skills. RPNs should be able to make decisions and assess the consequences of their choices during care delivery. For example, there was a time we had a very sick child who required a chest x-ray as part of the diagnostic procedures to establish an underlying illness. The physician was under pressure to obtain this test for decision-making about a change of medication. On my assessment, I observed that the child was not stable for transportation to the x-ray room because he was on oxygen and could require special attention on the way. I decline the doctor’s instructions to get the x-ray done at that time and requested more time to ensure all necessary tools were available before the procedure (Competency #58).
It took a few hours before all arrangements were made and upon getting the x-ray, the child had pleura effusion that required tapping. Unfortunately, the delayed response to the x-ray made the patient deteriorate and tapping did not save his life. Although the doctor believed the right call was to rush for the x-ray, I explained that without oxygen and resuscitative equipment on the way the child could not have survived (Competency #55). The actions leading to the death of the patient were analyzed by the hospital committee and my call was justified given the circumstances.
Disruptive behavior often arises from stress associated with being sick, the financial burden of illness, or the loss of a loved one. RPNs should know how to deal with disruptive behavior including any form of violence during care delivery. For example, on several occasions, I have observed violent behavior when breaking bad news to relatives. To mitigate this situation, I always ensure breaking the news is done in a separate room away from the patients to allow any sort of grieving and privacy that may be required. When violent behavior is suspected, calling security before breaking news is a strategy that serves to protect nurses in the unit (Competency #59).
Caring for sick patients requires the nurse to be active and quick to respond to deteriorating patient conditions. RPNs are prepared to assess deteriorating patient conditions and call upon assistance from physicians and RNs to plan for the right care. For example, I was caring for a patient in the pediatric unit admitted after sustaining an injury leading to right lung collapse. After a few hours of stabilization, I noticed that the patient’s breathing changed, became restless, irritable, and flaring nostrils. To respond to this situation, I put the patient on 4L of oxygen per minute using a nasal cannula, propped him up, and immediately called for help (Competency #60). These interventions improved the patient’s conditions before the doctor arrived to further reassess the patient.
Registered practical nurses are prepared to provide nursing care and possess knowledge in areas of pharmacology, nursing theory, health science, and ethics. The application of this knowledge should be appropriate depending on patient assessment and the situation at hand. For example, when I was in the pediatric unit, I managed a patient whose parents were reluctant to consent to treatment including signing the consent for surgery. I understood that the patient solely depended on the parents to make decisions and they had the right to refuse medical interventions for their child (Competency #61). I had to report this incident to the nursing manager who later collaborated with the physician and administration to determine the right course of action.
Administration of medication is among the duties of RPNs that should be exercised with competency. The nurse should possess good knowledge of pharmacology and principles of safe medication practice. For example, when administering medications to children in the pediatric ward, I always ensure to confirm the five rights of drug administration including seeking consent from the parent (Competency #62). Ensuring the right patient, right drug, right dose, right route, and right time are applied during medication administration is important to prevent errors.
Respect for patients’ values, preferences, and expressed needs is important during nursing care delivery. The nurse should engage clients in identifying their health needs and making appropriate choices during treatment (Haddad & Geiger, 2021). For example, When I worked in the pediatric unit, I worked with malnourished children who required great attention from both healthcare providers and parents to manage their condition. I ensured that we had daily goals established by the nursing team in collaboration with the parents and the patients when necessary (Competency #63). Setting goals with the patent and family was effective in promoting practices like feeding, infection prevention, and exercise that promoted the patient’s health.
Patient-nurse communication is a complex interpersonal interaction that requires an understanding of each party’s emotional state. Despite the complexity of this relationship, nurses should communicate collaboratively with the patient and other healthcare team members (Fleming & Willgerodt, 2017). For example, when I worked in the pediatric unit, I used to communicate every aspect of care to the patient and the parent if available. I could make calls to confirm with the physician when special care was needed and make interventions based on mutual understanding between the physician and the patient (Competency #64).
Communication of patient information is important for healthcare providers to allow continuity of care. One of the areas where providing essential information is necessary is shift change for nursing teams. For example, during shift handoffs, I ensured communication of patient information including diagnosis, interventions, and recommendations before leaving the facility. I also ensured to inform the patient and the family that someone else was in charge of their treatment to promote understanding (Competency #65). When test results were out, I ensured to communicate the same to the patient and document results in the EMR for other members to have access.
Interpersonal relationship in nursing refers to the interaction between two or more individuals communicating during care delivery (Fleming & Willgerodt, 2017). Interpersonal relationships can exist between nurses, nurses and doctors, or nurses and patients among many other people. For example, when I was working in the pediatric unit, there was a family that did not approve the delivery of care to their patent by junior nurses. Students were frequently dismissed from the patient’s room and demanded more qualified nurses. As a junior nurse then, I took my time to explain to the family that the services provided were standard and under supervision. I also explained that there was a shortage of staff making it impossible for qualified staff to be available all the time. This communication method restored their trust and allowed other members of the healthcare team to provide care without hesitance (Competence #66).
Conflict resolution is a way for two conflicting parties to find a peaceful solution to their problems. Nurses exhibit conflict every day because of the busy nature of their work and disagreements regarding the best course of treatment. RPNs should recognize conflicts and use appropriate strategies to solve them. For example, there was a time I observed conflict between night duty and morning shift staff regarding the untidiness of the nursing station. The morning shift staff claimed that night duty members failed to clean their mess and intentionally left this task to oncoming staff. To solve this problem I involved the nurse manager and set rules on the tasks to be completed during every shift (Competency #67).
Healthcare policies and regulations are used to dictate the terms of service for nurses and procedures to follow for professional purposes. RPNs should understand the policies governing their work environment and appropriate channels to follow when violations are observed. For example, there was a time when the hospital demanded excess service from the nurses without compensation for work done. Nurses who worked overtime experienced challenges with receiving their payments and were required to fill out several forms before acceptance of their requests. To address this problem, an internal strike was organized to address the number of working hours according to the state laws and establish new procedures for receiving payment for overtime (Competency #68). This approach was effective in addressing the healthcare issue and led to the formulation of new policies regarding payments for nurses in the facility.
Interprofessional teams are made up of different members from two or more professions working together to care for patients. The nurse should collaborate with interprofessional teams and recognize their roles within the team (Fleming & Willgerodt, 2017). For example, I once attended a mortality meeting to discuss the circumstances leading to a patient’s death. As the covering nurse during that day, I understood that my role was to discuss the nursing interventions done and communications made with physicians and the patient. I used references from the nursing report written that day and justified the actions of the nurses who handled the patient that day (Competency # 69).
Aboriginal traditional healing is a common practice that is recognized to provide relief to health problems like cancer pain and stress. Nurses should be open to suggestions of using traditional healing methods when appropriate and help connect the patient with the healers. For example, there was a time I cared for a patient with cancer who was stressed because of his condition. To address this problem, I recommended the use of complementary therapy from traditional healers to provide emotional, psychological, and spiritual support (Competency #70). Although the practice cannot take away cancer, I knew that it could help the patient respond to treatment and improve his quality of life.
Unregulated care providers (UCPs) are individuals used to assist with personal activities of daily living. These individuals can also provide care outside their training with supervision by registered nurses For example, during care delivery, we would sometimes experience an influx of patients making it difficult to provide appropriate care to all. I occasionally assigned simple tasks like taking the patient’s vitals to UCPs to reduce the workload (Competency #71). I also educated these individuals on other tasks like breaking bad news to relatives and performing the last office.
The working environment of nurses has a close relationship with aspects of patient safety and quality of care. Maintaining a quality environment is key and entails things like staff motivation, engagement, and involvement in important decisions (Tsai, 2021). For example, when I was the assistant manager of the pediatric unit, I ensured that nurses had input on important decisions concerning their practice and patient care. The use of suggestion boxes and direct communication of issues allowed the creation of a positive working environment for staff and patients (Competency #73). I remember there was a time when the charge nurse canceled nurses’ annual leaves to address the shortage in the unit. Because of understanding in the unit, affected individuals questioned this action without fear and demanded an explanation from the unit manager (Competency #74). After peaceful talks, some staff was allowed to start their annual leaves while others agreed to wait.
Nurse mentorship is a synergistic relationship between experienced and beginning nurses aimed at encouraging professional growth between both parties. For example, I took two student nurses under my wing when I was working in the pediatric unit and became their mentor. I could occasionally teach them about time management, and how to deal with burnout and difficult tasks or patients during care delivery (Competency #75). During shifts, I could assign these nurses tasks and ensure they were accurately completed. I used briefing and debriefing sessions to address issues like time management and adverse events that most found difficult to manage (Competency #78). During the mentorship process, I also got to learn many things, especially time management through using a to-do list.
Working with interprofessional teams or groups requires the application of various principles like goal setting and effective communication (Fleming & Willgerodt, 2017). For example, when I was working in the pediatric unit, I collaborated with physicians and nutritionists to formulate a plan of care for a malnourished child. During the collaborative practice, I ensured that we set a common goal of improving the patient’s health within the shortest period possible followed by domiciliary care (Competency #76). The team regularly communicated through short meetings held twice weekly to discuss interventions made I and progress regarding weight and food intake. Within 14 days, the team was able to determine that the patient was ready for discharge and follow-up.
The patient’s family was prepared for transition care and informed about the course of treatment. Each member of the healthcare team provided education about food intake, hygiene, exercise, and the use of supplements. As the nurse in the interprofessional team, I informed the family about the importance of adhering to treatment recommendations to prevent the deterioration of the patient’s condition. The patient was also enrolled in the hospital follow-up program to ensure regular calls were made to ascertain progress and provide further guidance when needed (Competency #79). the use of the interprofessional team approach, in this case, led to massive improvement in the patient’s health after a few months of treatment.
Ajibade, B. (2021). Assessing the patient’s needs and planning effective care. British Journal of Nursing, 30(20), 1166-1171. https://doi.org/10.12968/bjon.2021.30.20.1166
Fleming, R., & Willgerodt, M. A. (2017). Interprofessional collaborative practice and school nursing: A model for improved health outcomes. OJIN: The Online Journal of Issues in Nursing, 22(3), 2. https://doi.org/10.3912/OJIN.Vol22No03Man02
Haddad, L. M., & Geiger, R. A. (2021). Nursing ethical considerations. StatPearls Internet. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Tsai P. S. (2021). The varied and multifaceted professional roles of today’s nurses. The Journal of Nursing Research : JNR, 29(3), e147. https://doi.org/10.1097/JNR.0000000000000438
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