A. Functional Differences
The Professional Nursing Organizations and Regulatory Agencies for Nursing are what nursing professionals look to for standards, guidance, support, rules and regulations, along with licensure and discipline if necessary. One example of a professional nursing organization (PNO) would be the American Nurses Association (ANA). The role of the ANA includes: promotion/ development of the nursing profession, involvement with legislation and policy making, supporting the nurse in order for the nurse to provide quality care for the those receiving care. The mission statement of the ANA is simple and direct… “nurses advancing our profession to improve health for all” (ANA, 2014). Individuals can become full members of this organization or be a subscriber. Full membership/ full access requirements include a Registered Nurse license and a membership fee. Subscribers can be non- RNs, paying a fee, but this does not include full access to all resources.
Being a member of the ANA presents many benefits including possible connections with all levels of medical professionals and access to a multitude of resources and articles. Reasons why a nursing professional may not become a member of the ANA could include unawareness of how easily membership can be obtained, knowing that membership fees exist, or the fact that many resources are accessible on the internet easily for free. Regulatory Agencies for nursing usually are at a state level, such as the State of Tennessee Board of Nursing (BON). The TN BON mission statement is direct and includes “… mission is to safeguard the health, safety, and welfare of Tennesseans by requiring that all who practice within this state are qualified and licensed to practice” (TNBON, 2014).
The TN BON is backed by the governor, which selects the members of the board and includes 11 members (10 nursing professionals/ 1 consumer). This board is responsible for 3 main areas for the state of Tennessee– licensure/ certification, education/ curriculum for nursing programs, and practice of profession. The TN BON deciphers and gains impressions of statutes and administration rules to determine the appropriate standards of practice in an effort to ensure the highest professional conduct (TNBON, 2014).
If a complaint is filed against a nursing professional or misconduct is suspected, it is up to the Tennessee Board of Nursing to complete an investigation. The TN BON then determines if discipline and/ or penalties are necessary. The TN BON can and will suspend or revoke nursing privileges, if deemed necessary, in order to protect the health, safety and wellbeing of individuals (TNBON, 2014). Access to the TN BON information and resources is mostly free, with all meeting notes even being posted for public viewing on the website.
B. Nursing Code Examples
The Nursing Code of Ethics is the guide for nurses to follow in regards to morals ethics and professionalism. It includes 9 provisions that nurses are obligated to utilize in order to provide the best possible care to clients. Although all of the provisions touch each and every aspect of my nursing profession, two examples that influence my practice as the nursing director of a youth residential behavioral facility are #2 and #4. Provision 2 states “the nurse’s primary commitment is to the patient, whether an individual, family, group, or community” (ANA 2014). Working with behaviorally challenged adolescents in a residential care setting is extremely complex at times. These situations are frequently complicated because the youth are often in state’s custody, but the parents rights are still intact. My primary concern is the youth in the facility, yet being mindful to include, notify, and educate the parents as well.
The complication part arises when the parent refuses to support or agree to the plan of care designed for the youth. With the child being in custody of the state, there are many strict guidelines that have to be adhered to in addition to the expected nursing duties and standards. The child’s mental, physical and medical health are the main priority and when the parents are resistant to treatment, we sometimes have to take a legal approach in order to provide the best quality care available. Provision 4 of the Nursing Code of Ethics states “The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of task consistent with the nurse’s obligation to provide optimum patient care” (ANA 2014). This provision surrounds my position of being a nursing manager completely! Being a nurse manager and directing youth care workers of the facility is an extremely big responsibility.
It is my duty and obligation to ensure the safety of not only the children in the facility, but also the employees that work there. I am accountable both professionally and personally, even when I am not physically in the building. It is my responsibility to make sure all jobs are delegated appropriately and all those concerned are safe plus secure with the best available care possible. Only some of the employees have formal education or training, such as nurses… most employees are actually trained in the facility by the managers and the nurses. I am responsible for making sure the youth care workers and other personnel are educated on proper interaction, safety, infection control, policies and procedures from a medical standpoint.
C. Professional Traits
Four professional traits from the American Nurses Association Code of Ethics that I bring, as a member, to the interdisciplinary healthcare team would be from Provision 1 and Provision 3. As a nurse manager, I display and am responsible for ensuring that all team members are well aware of “Provision 1.1 Respect for human dignity” (ANA 2014). Our clients are children, and they come from many different unimaginable backgrounds. These youth are due respect and have individual rights as humans no matter what their histories are. I am also accountable for myself and my department to display professionalism. “Provision 1.5 Relationships with colleagues and others” (ANA 2014) enforces the fact that we all are to be respectful of each other.
Being the supervisor, educator and discipliner of employees, I hold myself to a higher standard of professionalism and am very mindful of this provision when interacting with colleagues. The youth in this facility all have very diverse medical and personal histories. These histories could include sexual exploitation or abuse, which in turn could bring along sexually transmitted diseases (just to name one possibility). This is a devastating situation for anyone, especially a child victim. “Provision 3.1 Privacy” and “Provision 3.2 Confidentiality” (AMA 2014) are self explanatory… I and all employees, carry the responsibility for teaching, displaying, and ensuring these children have the upmost supported privacy and confidentiality. As a member of a healthcare team, strict following in this provision allows me to build a rapport with the youth, that may give insight into these diverse histories. This allows the team to give a more holistic treatment for the individual.
D. Nursing Theory/ Theory in Professional Practice
My personal nursing basis comes from multiple influences. One example of a nursing theory that has influenced me in my profession would be the theory of Patricia Benner (Cherry, 2011). The theory describes that there are five levels of nursing competence. These five levels include novice, advanced beginner, competent, proficient and expert level nursing. I have had experience in different areas of nursing and in every position held, I have had to learn something new. What this means to me is that even though I have held a nursing degree for some years now, I may be in a position where I am not the expert level nurse. When I began my current position in adolescent care, I was definitely not the expert level nurse… this is because my experience in nursing care had been based on adult health. I was a competent level nurse when I began working with my current employer and with four years of experience in adolescent care now, I still continue to learn something new on a regular basis, whether it be lab values, medication dosages, education for teaching or therapeutic interventions.
The contributions of Florence Nightingale seem to influence my nursing practice on a constant basis. Drive for a better way would be another way that Florence Nightingale’s contributions influence my practice. Her never ending drive to improve conditions for better healthcare is historically documented from improving the conditions in the military hospitals, sanitation, public health and use of documented statistics are just a few of the amazing things that Nightingale accomplished (Cherry, 2011). As a practicing nurse manager, statistics and documentation is utilized and thrived upon in my daily routine. Vitals, nutrition logs, sleep patterns, probability of incidences and behavioral changes are some of the areas that I study and document. Statistics and documentation surround every approach in modern day application in the medical world.
As I noted earlier, working with children and their families can be extremely complicated at times. Beneficence and nonmaleficence are 2 principles that I work diligently to safeguard my clients and families with. Beneficence is “an ethical principle stating that one should do good and prevent or avoid doing harm; …to promote goodness, kindness and charity” (Cherry, 2010). Nonmaleficence is ” an ethical principle stating the duty not to inflict harm; …to help others further their own well being by removing harm and eliminating threats” (Cherry, 2010). An example of this would be when an adolescent with extreme self- harming behaviors was admitted to our facility for another primary diagnosis. During the admission assessment, the child revealed her hidden behaviors by showing multiple scars, then stated “my parents don’t know, please don’t tell them”.
My first priority was to ensure the child’s safety by removing objects that she could possibly harm herself with and notify the staff to heighten the level of awareness for safety precautions. Next, I explained to the child that it was necessary for me to inform her therapist and parents out of concern for her safety and to help prevent further harm. After explaining my reasoning to the child as to why it was necessary to inform her parents, she agreed that it was in her best interest to share this information in order to begin the process to rehabilitation. Trust and honesty and the promotion of this child’s health made this particular situation difficult but easy at the same time.
Nursing is a complex profession that includes guidelines that are headed by PNO’s and Regulatory Agencies. The Nursing Code of Ethics is the golden rule for moral and ethical nursing practice and this code is non-negotionable. Professional traits of the nurse play a huge factor when dealing with others, whether it be colleagues, patients or the public. There are many historical theorist and medical nursing icons that have laid the foundation for the nursing profession and practice. These theories and models are still contributing to the nursing profession in modern times and there are many examples of this that can be discovered within the nursing profession as well as my own practice.
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