Professional Accountability: Evidence based practice reflection

1. Nursing Theory

The nursing theory that has influenced my values and goals is Jean Watson’s human caring theory. This theory points out that caring is the core of nursing and the moral ideal of the profession whereby the result is the protection, preservation, and enhancement of human dignity (Pajnkihar et al., 2017).

A1. Excellent Nursing Practice

Nurses can apply Watson’s theory of human caring through the use of carative factors. Watson identified ten carative factors that provide the structure of caring and guide professional nursing practice. For example, the formation of a human-altruistic value system is a factor that allows nurses to treat patients as if they are members of their own families (Pajnkihar et al., 2017). The application of this factor during care delivery enhances the quality and improves patient satisfaction. Nurses also apply the theory through the promotion of interpersonal teaching-learning (Pajnkihar et al., 2017). The implementation of educational approaches to managing issues like increased readmission demonstrates excellent nursing care.

A2. Professional Practice

Watson’s human caring theory fits my professional practice because it is based on the core values of kindness, equality, and equity. The demonstration of kindness during care delivery allows me to genuinely attend to the needs of every patient and form strong bonds with my patients. To effectively improve patient outcomes, I regularly engage in teaching patients and families about maintaining their health. I have also engaged in continuing education to learn more about new ways of delivering care and improving the patient’s health.

1. Historical Nursing Figures

The first historical figure that I would like to acknowledge is Florence Nightingale. Nightingale revolutionized nursing care delivery during the Crimean War by gathering essential information on how hygiene practices influenced patient outcomes (Mathews et al., 2020). The second historical figure is Mary Breckinridge who dedicated her nursing career to helping mothers and children (Gulley, 2022). Breckinridge’s contribution to the nursing profession involved the creation of the Frontier Nursing Service which saw nurses travel to visit expecting parents and children.

B1. Difference in Contributions

Florence Nightingale is deemed the founder of modern nursing because of her contributions to hygiene. Her contributions improved hygiene practices in hospitals and reduced death rates by two-thirds (Mathews et al., 2020). Additionally, Nightingale pioneered preventive nursing by designing best practices for infection prevention in healthcare. While Nightingale influenced modern nursing through the promotion of hygiene practices, Breckinridge’s influenced nursing care for children and pregnant women (Gulley, 2022). She promoted the care for women by ensuring health promotion in rural communities.

B2. Influencing Professional Nursing Practice

The two historical nursing figures have influenced my nursing practice in the areas of quality care and patient-centered care. In the aspect of quality, Nightingale was tireless in her efforts to improve hospital conditions (Mathews et al., 2020). During care delivery, I always work with colleagues to ensure patients stay in a clean environment. The application of evidence-based practices like hand hygiene to reduce hospital-acquired infections is another area that demonstrates professional nursing practice. I have managed to use Breckinridge’s approach to educate patients including pregnant mothers on how to improve their health. Additionally, I have been involved in matters of policy advocacy to ensure the health of populations in rural communities is improved.

1. State Board of Nursing VS. American Nurses Association (ANA)

The state board of nursing is a government body that is involved in overseeing nursing licensure and setting the standards of nursing practice within its jurisdiction. Every state including the District of Columbia has a nursing board that deals with nursing licensure. The American Nursing Association is a national membership organization for all nurses across all states. This body functions to represent the interests of nurses and the nursing profession.

C1. Roles of Organizations

All boards of nursing are responsible for evaluating applications for nursing licensure. The boards ensure that nursing licenses are renewed and take disciplinary action against those that fail to adhere to professional nursing standards. Depending on the state, nursing boards authorize the use of particular licensing examinations. The boards are responsible for approving nursing education programs that meet established criteria. The American Nurses Association functions to represent the interests of the nation’s 4 million registered nurses. The role of the organization is to foster high standards of nursing practice and promote a safe and ethical work environment. The ANA also functions to advocate for the health care issues that affect nurses and the public.

C2. BON & ANA Influence

The board of nursing is a professional organization that ensures nurses practice ethically and follow the standards of nursing practice. During care delivery, my primary role is to provide safe care that benefits the patient. The board, through the formulation of the standards of care, ensures that I follow the ethical standards of care like beneficence and non-maleficence for safe nursing practice. Additionally, the board influences my practice through stipulation of consequences of malpractice and failure to renew licensure. During care delivery, I have to ensure my practice is within the required scope and report any issues that may impact the quality and safety of patients. The ANA influences and guides my nursing practice in the areas of advocacy and policy formulation. The organization helps me to recognize the factors influencing quality care to patients and safe nursing practice across all states.

C3. Professional License Renewal & Maintenance

In the state of California, a registered nurse license expires every two years and must be renewed for one to continue practicing. All nurses who wish to maintain an active license must complete 30 contact hours of continuing education (California Board of Nursing, 2022). Secondly, those renewing the license to active status are required to furnish a full set of fingerprints to the department of justice. License renewal is done online and all applicants are required to pay a renewal fee of $190.

C3a. Failure to Maintain License

There is no grace period from the time a license expires until its renewal in California. When a license expires, the nurse is legally not required to work in the state. If an individual pays the required fee during renewal but fails to complete the required 30 hours of continuing education, their license is put on an inactive status (California Board of Nursing). Those who fail to meet the two requirements see their licenses put on a delinquent status and may be required to pay a certain fee before their renewal.

 

C4. Compact Vs. Non-Compact State

The nurse licensure compact (NLC) allows nurses to work in multiple states using one license. Examples of compact states include Alabama, Kansas, and Indiana while non-compact states include California, Nevada, and Oregon. To apply for renewal in compact states, one must have a state of residency within one of the NLC states. In both compact and non-compact states, license renewal is done online. In some states like Indiana, expired licenses over 18 months must be renewed by mail. Application for renewal fees are applicable across these states but vary according to the area of residence. For example, the California license renewal fee is $190 while the NLC license renewal in Indiana costs $60.

1. FDA & CMS Functional Differences

The Food and Drug Administration (FDA) functions to protect the health of the public by ensuring the safety, efficacy, and security of human and veterinary drugs. The organization is responsible for ensuring these products meet certain quality standards before they are introduced to the market (Food and Drug Administration (FDA), 2018). The Centers for Medicare and Medicaid Services (CMS) is a federal agency responsible for administering the country’s major health programs including Medicare, Medicaid, and the Children’s Health insurance Program (CHIP) (CMS, 2021).

D1. FDA & CMS Influence

The FDA influences my nursing practice by guaranteeing that I am administering safe medication to patients. Apart from the administration of medication, the organization ensures that the equipment used is safe and I can reassure patients to use this equipment to improve their health (FDA, 2018). The CMS influences my nursing practice by ensuring that patients get adequate care irrespective of their financial status. I am also able to recommend the best therapies and provide referrals for special care because I know the CMS will cover these costs (CMS, 2021).

D1a. Nurse’s Role as a Patient Advocate

My advocacy role as a nurse when the patient seeks alternative therapy is to educate them and assist choose the most appropriate therapy. My role is to provide patients with a variety of alternative therapies, research their effectiveness, and recommend those approaches that can help them manage their illnesses. Another crucial role in collaboration with specialists like local priests and community nurses is to locate specialists that can handle the patient well.

1. Nurse Practice Act

The Nurse Practice Act (NPA) is a law that mandates the board of nursing to set out the scope of practice and responsibilities for registered nurses. The NPA exists to protect the public from healthcare providers who may be a risk to the health and safety of the people in the state. The NPA impacts my professional practice by ensuring that I provide care according to set guidelines and assume only responsibilities under my scope of practice.

E1. Scope of practice for RN

The scope of practice defines the roles, functions, responsibilities, and activities that registered nurses are competent to perform. In California, registered nurses are tasked with providing direct and indirect patient care services that ensure safety, personal hygiene, and protection of patients (Department of Consumer Affairs, 2011). The RN can do the observation of signs and symptoms of illness and implement care based on the observations. In other departments like reproductive health, RNs can dispense self-administered hormonal contraceptives approved by FDA including injectable contraceptives.

E2. Rules for Effective Delegation

Registered nurses in California can delegate the implementation of care to other staff for a reason. However, the RN must ensure that the subordinate is equipped and qualified to deliver care to the patient on the nurse’s behalf. The nurse must follow the five rights of the delegation including the right task, right circumstance, right person, right communication, and right supervision (Department of Consumer Affairs). Delegation to LVN must be supervised and the nurse should monitor performance to assure compliance with established standards.

1. Application of Nursing Roles

Scientist: As a scientist, my role is to use evidence-based practices to influence patient outcomes. For example, I will research for evidence-based approaches to improve communication among nurses to reduce medication errors. The use of standardized communication tools like SBAR is among the strategies that I can use to improve communication in healthcare.

Detective. My role as a detective is to use clinical imagination coupled with nursing science to detect problems and prevent adverse outcomes. For example, I will apply the root-cause-analysis (RCA) method to determine the causes of adverse outcomes and use the information to implement new changes that can improve healthcare outcomes.

Manager of the healing environment: My role is to coordinate care in the healing environment and advocate for better services that can improve quality outcomes. For example, I will collaborate with nurses and doctors to implement policies that can reduce waiting time that is observed to affect patient satisfaction and patient outcomes.

 References

California Board of Nursing. (2022). License/certificate renewal: General information.  https://www.rn.ca.gov/licensees/lic-renewal.shtml

Centers for Medicare and Medicaid Services. (2021). History: CMS’ program history. https://www.cms.gov/about-cms/agency-information/history

Department of Consumer Affairs. (2011). Board of registered nursing: An explanation of the scope of RN practice including standardized procedures. https://www.rn.ca.gov/pdfs/regulations/npr-b-03.pdf

Food and Drug Administration. (2018). About FDA: What we do. https://www.fda.gov/about-fda/what-we-do#:~:text=The%20Food%20and%20Drug%20Administration,and%20products%20that%20emit%20radiation.

Gulley, T. (2022). Review of: Wide Neighborhoods: A story of the frontier nursing service. Journal of Appalachian Health, 4(1), 63. https://doi.org/10.13023/jah.0401.07

Matthews, J. H., Whitehead, P. B., Ward, C., Kyner, M., & Crowder, T. (2020). Florence Nightingale: Visionary for the role of clinical nurse specialist. Online J Issues Nurs, 25(2). https://doi.org/10.3912/OJIN.Vol25No02Man01

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. PeerJ, 5, e2940. https://doi.org/10.7717/peerj.2940