My personal nursing mission statement is changing and developing as my career advances, however, one core piece will remain constant. I will strive to provide the best, safest, most ethical and compassionate nursing care that I can for all patients and family members with whom I come in contact. I began my post-high school academic career as an accounting major. I enjoyed the challenge of manipulating a report until I had balanced. I thought I had found my calling. As my first semester was nearing an end, I found myself contemplating the thought of sitting behind a desk all day. I wondered if I would find fulfillment in this work as a career? The more I pondered this thought, the more I realized that this was not the right career path for me. I saw images of the medical assistant program in the catalog at the school where I was attending. I could not shake the thought of the medical field for a profession. I attained my medical assistant degree and worked in the field for 10 years. The longer I worked, the more I realized that there was more that I wanted to do, but my current degree restricted me from going further.
I researched nursing school programs and selected one with a night/weekend program that would allow me to continue working full-time during my studies. I have a family that I needed to continue to provide for and this seemed to be the best fit. My nursing school decision was fortified when I was selected for an award by the nursing faculty from all four semesters for excellence in the clinical setting. After graduation, I began my nursing career working as a case manager for orthopedic worker’s compensation patients. During this time I gained critical knowledge of the importance of clear documentation, the ever-changing requirements of insurance companies and an extra measure of compassion for patients whose lives were often changed by traumatic injuries. This time helped me to develop personally and professionally as a nurse. From there I went on to develop an in-office infusion program for gastroenterology patients suffering from Crohn’s and ulcerative colitis.
This experience helped me to learn valuable organizational and time management skills. I also learned a vast amount about the challenges of GI issues for patients of every age. This opportunity gave me leadership skills, as I was responsible for a program that serviced two locations, management of nursing staff and medical assistants. I also learned a very human side of nursing, as my patients visited me every eight weeks and were here for two to three hours at each visit. I got to know them as individuals–mothers, fathers, children, students and employees. They became part of my life. To date there are nearly 70 patients for whom I am responsible. My next endeavor begins in one week.
I will be leaving my “baby” to one of the nurses I have trained, to embark on a new challenge. I will be learning to work in a surgical setting, at an ambulatory surgery center. I know this new opportunity will push me to grow further as a nurse, as I seek to learn critical care. I hope to develop a new level of compassion and expertise that I can then use to provide comfort and reassurance to the patients for whom I am responsible. I am excited about this new challenge and look forward to all that I can bring to it. I believe nursing should cause us to change and grow; to stretch us to reach new levels of education, knowledge and compassion. I will strive to continually learn as my career progresses to better myself and provide the highest level of care for my patients.
What is the functional difference between a regulatory agency, such as the board of nursing, and a professional nursing organization? While there are some overlapping concepts, for the most part they are very different in function. Both regulatory agencies and professional nursing organizations are concerned with equipping nurses in ways to provide the best, safest, most effective and ethical care. They differ in that a regulatory agency is just that, regulations. They set up rules that govern the way in which a nurse provides care to their patients. These regulations are not suggestions, but requirements that are expected of all nurses in all situations. Regulatory boards are not made up of “memberships” like a professional nursing organization. Regulatory agencies require certain standards for individuals to achieve to be licensed to provide nursing care.
The public can gain reassurance about the nursing profession from knowing that nurses are regulated by a board of nursing. Professional nursing organizations (PNO), on the other hand, are optional memberships. One can choose to be part of an organization that will help to advance oneself in a specific area of nursing, such as the American Academy of Occupational Health Nurses (AAOHN), the Academy of Medical-Surgical Nurses (AMSN), the American Nurses Association (ANA), or the American College of Nurse Midwives (ACNM). (Monster staff) The list of PNOs is quite extensive and includes organizations for most any nursing specialty. PNOs also seek to shape health policy or public policy related to health matters. (unknown1) Professional nursing organizations work to advance public awareness of their branch of nursing or the nursing profession as a whole. They also seek to draw public attention to the nursing profession as a whole.
There are many factors in a nursing code of ethics that guide how I choose to practice as a nurse. I will now explain how two components of a nursing code of ethics taken from the American Nurses Association guide my personal nursing practice. First I will look at, “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” (American Nurses Association) This principle has affected me personally, in that in my current position of developing an infusion program for my office, I have been responsible for evaluating patients for the appropriateness of care in this setting. I am required to look at their health conditions, their emotional status and their insurance to determine if they meet the abilities of our in-office staff to provide excellent, safe, compassionate care. It is imperative that I am non-judgmental and look at each patient as an individual.
Their personal health needs must be foremost in my mind when I decide if we can care for them appropriately or not. It is a lot of responsibility and very difficult at times. I do believe I have been successful in this in that we have nearly doubled the number of patients we care for in the last six months. Second, ”The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.” In my current role, I am responsible for over-seeing other nurses and medical assistants in provision of care for our patients. It is imperative that I am certain that we are providing care that is within our scope of practice.
Often, in an office setting, the doctors get comfortable with the skills of their nursing staff and request tasks, expecting that we will take care of them properly. I must be certain that orders are properly documented and signed by the providers and that I am not doing or asking others to do tasks that are not within our scopes of practice. On a weekly basis I find things that need to go back to the provider for clarification or reassignment for management by appropriate staff. This is paramount to assure safe care and ethical treatment of patients, as well as protection of staff from inappropriate expectations.
In my upcoming role as a nurse in a surgical setting, I will be working daily with an interdisciplinary team of ordering physicians, surgeons, anesthesiologists, LPNs and many others. My practice will be guided by the following four divisions from the American Nurses Association: 1) nurses and people, 2) nurses and practice, 3) nurses and the profession, and 4) nurses and co-workers. (Lyons) First, as discussed in provisions 1-4, nurses and people considers all people, not just patients. This means I will consider families and other people involved in the patient’s care or life. Nurses and practice, from provisions 5-8, will require me to stay educated and aware of the current standards of practice and ethical guidelines by which a nurse should practice.
According to provisions 5-9, by following the guideline of nurses and the profession, membership in PNOs will be important in helping me to stay aware of current standards for the specialty in which I am working, as well as current healthcare policy or legislation that is being negotiated. As a professional nurse, it will be important for me to be involved in advocating for the policy that I believe best suites the patients for whom I care. Lastly, as outlined in provisions 5-6, nurses and co-workers is of significant importance. New nurses often hear, “nurses eat their young”. I do not believe this should ever be the case. Our job is to guide and educate our patients. Why then, wouldn’t we be willing to help those fellow nurses in their work and development? I will seek to help my fellow co-workers, whether they are nurses, LNAs or other professionals to provide the best care and maintain a healthy work environment in which all co-workers are valued for what they have to offer.
One nursing theory that has influenced my nursing practice to date is Dorothea Orem’s “Self-Care Theory”. In Orem’s theory, she states that a person’s well-being is based on whole person health, to include both physical and mental health. In addition, she takes into consideration the social and interpersonal aspects of the person’s well-being. This theory is based upon individuals being responsible for their own care and the care of their family. This theory impacted my nursing practice significantly during my time as an orthopedic nurse case manager.
It was of the utmost importance that patients took responsibility for their health, both for the sake of their physical status, as well as for the maintenance of their position at their place of employment. Orem’s theory also states that individuals need to be aware of potential health problems. This is important in worker’s compensation case management because patients needed to be aware of their ability to perform their work tasks. This sharing of information helped me to be a greater advocate for my patients with their providers and employers. As I continue on into a surgical setting, this theory will also be important as patients will need to know what to anticipate after their surgery physically, emotionally and socially.
The nursing figure who immediately comes to mind as having an impact on my nursing practice is Florence Nightingale. I have known of her since my childhood, even before I knew I would grow up to be a nurse. I did not study her closely until I began nursing school. The reason I have selected Florence Nightingale is that she had such a significant impact on ground-breaking theory that led into today’s aseptic techniques. Ms. Nightingale led a team of nurses who helped to reduce the mortality rate for wounded soldiers during the Crimean War by two-thirds. (Unknown) Thanks to her careful attention to detail and relentless desire to help others, she studied the unsanitary conditions under which her patients were being cared for. She then developed new hygiene practices that created lasting impact on today’s medical profession. This information is the ground work for what will guide my aseptic practices in a surgical setting, as well as those that I used working in wound care in the orthopedic specialty. They are the basis for infection control in all healthcare settings. She was far ahead of her time.
I recently had a situation with a patient where I had to exercise beneficence and respect for autonomy. My patient was having a reaction to an infusion of a medication called Remicade. This was her first dose being done in this clinical setting, and her second dose overall. Within the first 15 minutes of her infusion, I watched as she went from talkative and seemingly fine, to flushed, diaphoretic and shaky. I called the physician to get his input. He advised that I continue with my plan to hold the medication and run normal saline for a period of monitoring. We would reassess in 20 minutes to see if we could restart her infusion. As the end of the 20 minutes of normal saline was approaching, the patient seemed to deteriorate. She began to have rigors. This was not a typical infusion reaction. It was not listed in any of the research or clinical articles of which I had read. I called the physician back. As I did so, the patient expressed concern about whether or not he was going to send her to the hospital.
She desperately did not want to go. Over the last 5 months, she had been in and out of the hospital for extended periods of time. The thought of returning there frightened her. The physician suggested that she should go to the emergency room. As she expressed concern about going, he glanced at me. He then requested that I consult with her ordering physician. Upon calling the ordering physician, I could have expressed concern about her condition. I could have told him that I thought the other physician was correct. However, there was something in her request that seemed very controlled. Her vital signs were stable. I knew I was surrounded by help if it was needed.
I trusted the patient’s request to remain autonomous. The ordering physician also felt that the patient would benefit from staying at the infusion center if she was physically able. I assured him the situation was under control and that I would transfer her immediately if her condition worsened. The patient stayed with me for monitoring for another 2 ½ hours. Her condition improved and she was able to safely return home without having to visit the emergency room.
Beneficence is “action that is done for the benefit of others”. (Pentilat) I believe I acted with beneficence in making this decision to keep the patient with me. I believe the stress of a transfer to the emergency room may have made her condition worse and may have caused her to be admitted again. I have seen this patient since then and she has assured me that the extra time I had given her in the office impacted her both physically and emotionally. It is situations like this that make me truly love my job. It is times like this that I know nursing is not a job, it is a calling.
American Nurses Association. Code of Ethics. (2015) Retrieved May 8, 2015 from http://www.nursingworld.org/Mobile/Code-of-Ethics Monster staff. The Ultimate List of Professional Associations for Nurses. (2015). Retrieved May 8, 2015 from http://nursinglink.monster.com/education/articles/11850-the-ultimate-list-of-professional-associations-for-nurses Nursing Excellence, The Online Newsletter for Children’s Nurses, e-Edition, Issue 9, Code of Ethics for Nurses, Jo A. Lyons, MOB, BS, RN-BC, Retrieved May 8, 2015 from http://www.valleychildrens.org/PRESSROOM/PUBLICATIONS/NURSINGEXCELLENCE9/Pages/CodeOfEthicsForNurses.aspx Pentilat, S., Beneficence vs. Non-maleficence. (2008) Retrieved May 9, 2015 from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_bene_nonmal.htm Unknown1. Differentiating the Roles of Regulatory Bodies and Associations for Health Professionals, A Background Document. (Feb. 2010) Retrieved May 8, 2015 from http://www.nursing.ubc.ca/Scholarship/RNNetwork/documents/Differentiating%20the%20Roles%20of%20Regulatory%20Bodies%20and%20Associations%20%20-%20Feb%202010.pdf
Unknown2. Florence Nightingale. (2015). The Biography.com website. Retrieved 07:54, May 09, 2015, fromhttp://www.biography.com/people/florence-nightingale-9423539.
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