The Professional Nurse

Historical Themes
role of woman, religion, war
History of Nursing
Early AD
-Christianity’s influence
-Religious personnel acted as nurses and doctors

16th century AD
-Loss of religious personnel to care for sick
-Women who committed crimes worked as nurses instead of going to jail

1700’s
-Slaves as nurses
-Revolutionary War

1800’s
-“modern” nursing began
-Florence Nightingale
-Crimean War
-Male-dominated society
Late 1800’s
-Civil War
-Schools of Nursing
Early 1900’s
-19th Amendment- women’s rights
-Great Depression- need for Public Health

1940’s
-World War II
-Increased need for nurses
-Increased medical knowledge
-Shift in nursing education

1960’s-1970’s
-Vietnam War
-Technology
-Feminist Movement

Types of Nurses
-licensed practical nurse (LPN)
-registered nurse (RN)
Licensed Practice Nurse (LPN)
-NOT a registered nurse
-scope of practice different than an RN
-Approx. 18 months of training
-licensure through an exam
-NCLEX-PN
Types of Entry Level Nursing Education Programs (RN)
-diploma
-hospital based
-3 years
-Associate’s Degree (ASN)
-community college or other colleges
-2 years
-Baccalaureate (BSN)
-at colleges and universities
-4 years
Baccalaureate “RN”
-Professional Registered Nurse
-Liberal arts background: scientific and humanities knowledge
-Acts as a leader and is politically aware
-Applies and evaluates nursing research in clinical nursing practice
-Longstanding debate to make BSN entry level degree for nursing
Licensure
-A license certifies “entry level competence” of the nurse
-A nursing license is necessary to practice nursing

-RN’s are licensed by the State Board of Nursing
-State Boards of Nursing regulate nursing practice!
-If an RN relocates, he or she may receive licensure in a new state through reciprocity
-Most states require Continuing Education credits (CE’s) for license renewal

How do you get a license?
1. Graduate from an entry-level nursing program (Diploma, ASN, or BSN)

2. Take and pass the NCLEX-RN exam!

NCLEX-RN
-National Council Licensure Examination for Nurses
-Must pass the NCLEX-RN to get a license as RN
-without a license can not practice as RN
-Though licenses are issued by state, all RN’s take same licensing exam
NCLEX-RN Exam
-Computerized exam
-Tests for basic entry-level competency
-Questions may range from 75-265
-Maximum of 5 hours for exam
-Various question types including:
-Multiple choice
-Select all that apply
-“hot spots”
-Drag and drop
Certification
-Certification validates a higher level of expertise, specialty knowledge, experience and clinical judgment in a specific area
-Optional
-Examples
-CCRN-> critical care certification
-CRNP= Certified Registered Nurse Practitioner
-CRNA= Certified Registered Nurse Anesthetist
-CNE= Certified Nurse Educator
Progression of Nursing Education
-Diploma/ ASN -> BSN -> MSN-> PhD/ DNP
-After licensure, BSN can practice as a generalist nurse
-advanced practice nursing roles require advanced graduate education
Graduate Education in Nursing
-Master’s of Science in Nursing (MSN) provides specialization
-Clinical Specialist
-Nurse Practitioner
-Nurse Anesthetist
-Nurse Midwife
-Nurse Educator
-Research Doctorate-RN’s with research doctorate (PhD/ DNSc)
-complete a dissertation
-are expected to do research
-often work as professors in schools of nursing
-Clinical Doctorate (DNP)
-Doctoral level degree for CLINICIANS
-Nurse practitioners, nurse anesthetists, nurse midwives
-NOT a research doctorate
-Clinical doctorate
-No dissertation
-Newly developed degree
-Programs being established across the country (currently close to 200)
-Will be entry-level for advanced practice nurses at some point- state by state decisions on when this will happen
Roles of the Nurse
-researcher
-advocate
-teacher
-leader
-all nurses display all roles!
Nurses as Researchers
-Research consumers
-EBP
-Participants in research studies
-The Nurse’s Health Study: The Nurses’ Health Studies are among the largest and longest running investigations of factors that influence women’s health. Started in 1976 and expanded in 1989, the information provided by the 238,000 dedicated nurse-participants has led to many new insights on health and disease. While the prevention of cancer is still a primary focus, the study has also produced landmark data on cardiovascular disease, diabetes and many other conditions. Most importantly, these studies have shown that diet, physical activity and other lifestyle factors can powerfully promote better health.
-Caring for patients involved in clinical trials & other research studies
-Principal investigators
-Responsibility to share results of research findings through presentations & publications to enhance nursing knowledge
Nurses as Advocates
-Advocate for:
-patient’s needs and desires
-the profession
-Evidence Based Practice (EBP)
-Professional membership and representation of Nurses
Nurses as Teachers
-all nurses teach
-patients
-students
-families
-peers
Teaching Careers
-Clinical nurse educator
-educate other nurses
-Patient or professional education
-ex. diabetic educator
-Faculty
-faculty are also researchers
Nurse as Leader
-All nurses are leaders
-nurse managers (clinical) (business)
-role includes planning, organizing, directing/ motivating and controlling resources to deliver quality care to clients and families
-focuses on business, practice, etc.
Nursing Career Roles
-Acute care staff nurse
-Outpatient
-Home care / Community / Parish
-Manager
-Educator
-School
-Nurse practitioner
-Forensics / Legal
-Anesthesia
-Midwifery / Pediatrics
-Oncology
-Genetics
-SO many choices
Professionalism
-the conduct, aims, or qualities that characterize or mark a profession or a professional person
Professionalism in Nursing
-Professional behavior
-Professional appearance
-Practice evidence-based care delivery
-Professional development and a passion for life-long learning
-Collegiality and collaboration
-Adherence to nursing values and ethical principles
-Participation in professional organizations to advance the profession
Professional Organizations
A profession must have professional organizations that set standards for practice and education
Benefits of Belonging to Professional Organizations
-Network with colleagues
-keeping current with trends and issues related to the profession
-being involved in legislation and politics of interest to the profession
Some Professional Nursing Organizations
-American Nurses Association (ANA)
-Sigma Theta Tau International (STTI)
-National League for Nursing (NLN)
-American Association of Colleges of Nursing (AACN)
-Student Nurses’ Association of PA (SNAP)
-National Student Nurses’ Association (NSNA)
-Specialty Organizations
American Nurse’s Association: ANA
-Largest nursing organization in U.S.
-Establishes standards of nursing practice
-Deals with health care political issues
-Comprised of state level nursing organizations
Sigma Theta Tau International: STTI
-International Honor Society of Nursing
-Focus on Research, Education, and Service
-Can be inducted as a student if meet criteria (minimum GPA, amount of program completed)
-Can be inducted as a practicing nurse if nominated as Community Leader.
National League for Nurses: NLN
-Promotes nursing practice and education
-1 of 2 organizations responsible for accreditation of nursing education programs
-can accredit nursing programs at any degree level
What is accreditation?
-optional periodic evaluation of evidence of predetermined standards-if the standards are met, accreditation is awarded
-verifies quality of the academic institution and program
American Association of Colleges of Nursing: AACN
-Focus on baccalaureate and higher degree nursing education programs

-One of 2 organizations that can provide accreditation to schools of nursing
-CCNE= Commission on Collegiate Nursing Education
-Can only accredit BSN and higher degree programs
-Villanova College of Nursing is accredited through the CCNE

Student Nurses’ Association
-State-based
-ex. SNAP in PA
-NSNA= National Student Nurses’ Association
-Allows Student Nurses to become involved in a professional organization
-Villanova has the largest and most active chapter of SNAP in the state
Specialty Organizations
-Address the specific needs of various sub-specialties of nursing

Examples:
-Association of Pediatric Oncology Nurses
-American Psychiatric Nurses Association
-Association of Peri-operative Registered Nurses
-Emergency Nurses Association
-American Association of Critical Care Nurses
-Hospice and Palliative Nurses Association
-International Association of Forensic Nurses
-Many, many others!

Value
personal beliefs which guide one’s behavior: learned form family, cultural society
Belief
intellectual attitudes not always based on facts, sometimes based on faith or commonly held ideas
Value System
basis for your personal code of conduct: Nurses have specific code of conduct
-Nurses must understand the patient’s value system
7 Values Essential to Professional Nursing
-Aesthetics
-Altruism
-Equality
-Freedom
-Human Dignity
-Justice
-Truth
Aesthetics
-environment that is pleasing to the client
-a work environment that is pleasant
-promoting a positive image of nursing through care of self and environs
Altruism
-concern for the welfare of others
-caring, commitment, compassion generosity, and empathy
Equality
-provided care based on client’s needs in a non-discriminatory manner
-acceptance of other’s beliefs, fair treatment and tolerance of other’s values
Freedom
-honors client’s rights to make decisions regarding health care
-encourages client independence and self direction
-supports rights of other providers to suggest alternatives in plans of care
Human Dignity
-inherent worth and dignity of every individual
-safeguards other’s rights to privacy, confidentiality, respect
Justice
-act as client advocate when caring for clients
-non-judgemntal care of client regardless of client’s belief system
-allocates recourses fairly
-reports unethical or illegal practices factually
Truth
-Faithfulness to the facts and reality
-accountability in documentation and reporting
-accurately obtains facts prior to making decisions and judgments
-reflective and compassionate honesty with clients
Vales Clarification
-a process of discovery
-a person comes to understand himself better through feelings and analysis of behavior
-a person learns what choices to make when alternatives are presented
-to identify whether or not past choices were rationally made or are the result of past conditioning
The process of “Valuing”
-Involves: Choosing/Prizing/Acting
-Involves choosing better behavior, realizing the worth of that behavior, and actually doing what is necessary to achieve wellness
-understand that everyone has choices
-encouragement to prize wellness
-act in way which will be consistent with wellness
Ethics
-Systemic inquiry into the principles of right and wrong conduct, of virtue and vice and of good and evil as they relate to conduct
-ethics are based on values
-certain ethical principles guide our actions in health care
Bioethics
-ethics related to the “life sciences”
-Clinical ethics
-subset of bioethics and that deals with ethical issues at the bedside, during actual patient care
-Nursing ethics
-subset of bioethics specifically related to nursing practice
Ethical Theories: Utilitarian
-the right or wrong of an action depends on the outcome and consequences of that action
-ex. assisted suicide is right in cases of terminally ill patients to lessen the patient’s suffering and diminish the burden on society
Deontologic
-an action is right or wrong independent of its consequences
-ex. assisted suicide is wrong in all cases since it is ethically wrong to take away a life
Ethical Principles of Nursing
-Autonomy
-Non-maleficenece
-Beneficence
-Justice
-Veracity
-Confidentiality
-Fidelity
-Advocacy
Autonomy of the client (Ethical Principles in Nursing)
-the nurse respects the decision making ability of the client
-allows client to make judgments about his or her own health
-respect the right of the patient or surrogate to make healthcare decisions
-the patient needs to have accurate information before able to make a decision (informed consent)
Informed Consent (Ethical Principles in Nursing)
-advising the patient of their condition and all the possible consequences of any procedures and treatments they undergo
-also advising the patient of the possible consequences of not undergoing treatments or procedures
-obtaining written informed consent is out of the scope of practice for nurses-physicians must do this
Non-Maleficenece (Ethical Principles in Nursing)
-“do not harm”
-the nurse must avoid causing harm to the patient
-the nurse does not ever do anything that will intentionally hurt the patient
Beneficence (Ethical Principles in Nursing)
-the nurse acts in accordance with what will ultimately benefit the client
-the nurse has to weigh the risks and benefits of therapies
Justice (Ethical Principles in Nursing)
-the nurse distributes benefits, risks, costs, and health care resources fairly to all patients in a non-discriminatory manner
Veracity (Ethical Principles in Nursing)
-the nurse incorporates compassionate truth telling into patient counseling
Confidentiality (Ethical Principles in Nursing)
-the nurse respects the private privileged information of the client and does not share this information carelessly with others
Fidelity (Ethical Principles in Nursing)
-the nurse keeps promises made to the client
Advocacy (Ethical Principles in Nursing)
-protection and support of another’s rights
-the nurse represents the client best interest; the nurse speaks and acts for those clients who cannot speak of act for themselves
-nurse facilitates patient’s decision-making; the nurse does NOT make decisions for the patient!
-nurses may have the advocate for patients to family members, other healthcare providers
-nurses are patient advocates!!
Nurse Accountability
-the nurse is responsible for his/her actions
-the nurse is responsible to maintain his/her competence and safe practice
-the nurse is obligated to disclose his/her own lack of training or education in specific areas to protect the safety of the patient
Nursing Code of Ethics
-code of ethics describes the primary goals, values, and obligations of the profession
-International Council of Nurses (ICN) Code of Ethics for Nurses
-American Nurses Association (ANA) Code for Nurses
ICN Code of Ethics for Nurses
-ethical standards for buses related to:
-Nurses and people: involves care of patients, including: holistic care, patient education, confidentiality, responsibility to meet health and social needs of community and environment
-Nurses and practice: maintaining competence through continued learning, personal health, appropriate delegation, personal conduct, appropriate use of technology and scientific advancements
-Nurses and the Profession: EBP, research based professional knowledge, work with professional organizations to promote professional working conditions
-Nurses and co-workers: collegiality and professional collaboration
ANA Code for Nurses
-standards for practice and standards for care
-the nurse’s practice is guided by Code for Nurses
-compassionate care
-dignity of all people
-nurse’s primary commitment is to patient
-advocacy
-promote and protect patient’s health
-responsibility and accountability for own practice and appropriate delegation
-maintain competence
-integrity
-promote health healthcare environments and workplaces
-advancement of the profession
-promote community, national and international health
ANA Standards of Professional Practice: Ethics
-The nurse:
-maintains patient confidentiality
-acts as patient advocate
-delivers care in non-judemnetal, non-discriminatory manner
-protects patient autonomy, dignity and rights
-seeks available resources to help formulate ethical decisions
Patient Bill of Rights
-developed by American Hospital Association in 1972; revised in 2003
-provides rights and responsibilities of patient receiving care within the hospital
Bill of Rights for Registered Nurses
-ANA
-Goals:
-improve workplace for nurses
-ensure nurses’ ability to provide safe, quality care
-empower nurses
Ethical Distress
-when nurse knows right course of action, but personal or institutional factors prohibit following this course of action
Ethical Dilemmas
-when attempted adherence to basic ethical principles results in 2 conflicting courses of action
The Emerging Research Basis of Nursing and the Nurse’s Role
-research asks questions related to nursing practice, nursing education, etc.
-Nurses:
-apply research findings to practice
-critique existing research
-conduct research studies
-collect data
-interpret results
Roles of Various Nurses in Research: BSN/MSN
-apply research findings to clinical practice (evidence-based practice)
-critique research
Roles of Various Nurses in Research: PhD/ DNSc
-conduct research studies to ass new knowledge to body of knowledge for nursing and healthcare
Evidence Based Practice (EBP)
-nurses apply research findings to practice
-use most current, best evidence to make clinical decisions
-nurses critique existing research
-bedside nurses engage in Evidence Based Practice on a daily basis!
-Ex. Ventilator Associated Pneumonia, Foley Catheter Infections
Evidence Based Practice Steps:
1. ask question
2. collect most relevant and best evidence
3. critically appraise and validate evidence
4. apply evidence to clinical decision-making
5. evaluate outcome of decision
Why Use Evidence Based Practice?
-IOM Report (2001) “Crossing the Quality Chasm” challenged healthcare professionals to provide care based on scientific evidence
-To ensure quality and cost control, evidence that serves and interventions are effective is important
How do nurse find relevant research to use?
-computer databases of healthcare journal articles
-ex. CINAHL, Pubmed
-scholarly nursing journal articles are the gold standard for nursing knowledge
-most up-to-date information
-reliable
-peer-reviewed
-be careful with internet searches
Nursing/ Medical Databases
-CINAHL
-Cumulative Index of Nursing and Allied Health Literature
-Computer databases of nursing journal articles regarding a nursing topic
-PubMed
-interdisciplinary database of healthcare journal articles
APA Format
-From the American Psychological Association
-Format for writing scholarly papers in nursing
-Specific method:
-format paper
-cite references
-Most current edition is the 6th edition (2009)