Regulatory agencies, such as a state board of nursing, are government agencies that regulate nursing practice. They act to ensure nurses are competent in their practice and that standards of practice are met. These agencies examine nursing education programs, and are the ones who approve and accredit them. The agencies are responsible for granting licensure for nursing professionals and oversee the licensure exams. Their role also includes interpreting the state nurse practice acts and developing rules, regulations, and policies. When nurses do not follow those rules, regulations, and polices, or demonstrate unsafe behavior, the agencies are responsible for determining appropriate disciplinary actions against the nurse. Professional nursing organizations are non-regulatory groups that help nurses further their development through education and networking. These groups are great for sharing ideas, technological advances, and trends.
Often, there are fees to join the organization. Once a member, nurses usually are given a discount on literature and other educational courses. These organizations act as nursing advocates, and are often involved in advocating for new legislation to improve the nursing practice. There are a wide range of associations. One example would be the Ohio Council for Home Care and Hospice (OCHCH). The OCHCH is a major source of support to home care agencies in Ohio by advocating for improvements in laws affecting home health, helping to interpret those laws for it’s members, and offering a large array of educational classes. In my professional practice, I deal with the state board of nursing to keep up with licensure of our home health staff. I deal with the OCHCH on a daily basis to stay informed of new regulation, and current educational opportunities for myself and our staff.
The Code of Ethics for nursing is put out by the regulatory organizations, such as the state boards, and are also usually found on the website of various professional organizations, such as the ANA. In the Code of Ethics, Provision 4 states “The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care” (American Nurses Association, 2001). This statement from the code of ethics greatly influences my individual nursing practice, as well as my original decision to become a nurse. My father was diagnosed with multiple myeloma when I was 19. At that time I was in college studying mechanical engineering. Dad had many hospital visits over the next few years. I was amazed at the differences in the nurses, and their effect on his hospital experience. Some were excellent. They took care of his needs, both physically and emotionally.
Others, did not. During one hospital stay, he was suffering a great deal from pain. Despite multiple requests for pain medication, one nurse chose to sit at the nurses station and talk with co-workers about their upcoming Christmas party instead of bringing him his pain medication. It was at that moment that I decided to go into nursing as a profession. I had seen first hand what a difference a good nurse can make in a patient’s life, as well as a not-so-good one. I wanted to be one of the good ones. If I could make a difference in even one patient’s life, it would be well worth it. Many years later, I still hold myself accountable for my own nursing practice, and delegate appropriately when needed, in order to take optimal care of my patient’s needs. I treat my patients the way I would want my dad to be treated if he was still alive. Provision 2 states “The nurse’s primary commitment is to the patient, whether an individual, family, group, or community” (American Nurses Association, 2001).
This is important in any area of nursing. I work in home health, and I feel this is especially true with my patients. As a home health nurse, I am one of many nurses who are the eyes and ears of physicians in the home setting. I feel it’s important to see a patient in their home environment in order to assess family and cultural influences that might have an impact on the patient’s outcome. We can then develop and individualized care plan and work with the physician to help meet their needs. At times, I have found issues in the home and met resistance when talking with the doctor to get new orders. It’s important to advocate for the patient in those situations and clearly communicate the patient’s needs to the physician. There are 4 traits, or characteristics, within the Code of Ethics that I am going to discuss. The first is collaboration. I work in home health, and collaborate on a daily basis with other members of the interdisciplinary team.
As a case manager, I am constantly in contact with the nurses, physical therapists, occupational therapists, speech therapists, social workers, and physicians to make sure all of the patient’s needs are being met. Often, at the time of initial patient assessment, only nursing is ordered for the patient. If I see that the patient is a fall risk, is having trouble bathing and dressing, has trouble with swallowing or cognition, is depressed, or needs financial assistance, it is my responsibility to call the doctor and get orders to get other disciplines involved. Once they are involved, we work together, along with the patient and family, to come up with a care plan that is individualized for that patient. Throughout the patient’s course of care, we work together to make sure goals are being met. If not, we look at how we need to adjust the care plan in order to meet those goals. Confidentiality is another trait found in the code of ethics.
When working with an interdisciplinary team, it’s important to work on a need to know basis. For example, the speech therapist doesn’t need to know about the patient’s financial issues unless it would relate to the patient’s need to buy thickener for their food. The social worker, on the other hand, would need to know about the patient’s financial situation, in detail, in order to help the patient get set up with financial assistance in the community. Privacy is another trait that our multidisciplinary team deals with. In home care, it’s hard for the patients and families to allow others into their home, without feeling like their privacy is being invaded. It’s important to, as a team, build up trust with the patients. The various disciplines work together to coordinate our schedules to best fit the patient/family in order to help maintain that privacy. For example, rather than all scheduling a visit on the same day, we stagger our visits throughout the week in order to minimize our time in the home each day.
This actually helps with patient outcomes as well, because there is a skilled clinician in the home on most days that can keep their eyes and ears on the patient. Integrity is the last trait I will talk about. It’s important for me in home care to maintain moral integrity. It would be easy to falsify records, such as my time in and time out of a patient’s home. I feel moral integrity is important, whether practicing nursing, or in my every day life. I strive every day to uphold it. There have been many wonderful nursing theories over the years. One that I practice every day is Dorthea Orem’s self-care deficit model. Typically, a patient needs home care when they have suffered a debilitating accident or illness. As a nurse, it’s my job to find out what their self care deficits are, whether they be functional, cognitive, etc.
I then work to individualize a care plan that includes therapy, disease process education, etc., that will help them get back to their previous level of functioning if possible. If they aren’t able to return to their previous level of functioning, it’s my job to help them adapt to their current level of functioning in order to care for themselves, and prevent further decline. I feel that Jean Watson, who developed the theory of human caring, has had a big impact on my nursing practice. I think everyone, sick or not, wants to feel cared for. I try, as a nurse, to create an environment of caring for each patient I see. I feel it’s important to do this to provide an atmosphere for optimal healing. It can be difficult at times, especially in the home environment when there are other family members involved.
Most families are very supportive, but at times there are difficult family members who cause undue stress for the patient. This is when it’s my job to act as a patient advocate, and help those family members cope in a way that is healthy for the patient and caregivers. It is important as a nurse to abide by certain principles. Two of those principles are nonmaleficence and respect for autonomy. I opened a patient’s case for home care recently and found Coumadin, Aspirin, and Plavix listed on his discharge medication list from the hospital. I was concerned with this, but especially when I found him to be a high fall risk. I called the physician and confirmed that there had been a mistake on his discharge instructions.
He was new to Coumadin, and the Aspirin and Plavix were supposed to have been discontinued. This is an example of nonmaleficence. My goal was to protect the patient from harm. The same patient was released from the hospital with an acute COPD exacerbation. Once home, he continued to smoke a pack of cigarettes a day while on oxygen. I explained the disease process of COPD in a way he could understand, including why he should stop smoking. I also explained to him the risks of smoking while on oxygen. He chose to keep smoking. This is an example of respect for autonomy. It is our job as nurses to explain risks to them in a way they can understand. We have to respect their decisions at that point, whether we agree with them or not.
American Nurses Association (2011). Code of Ethics for Nurses With Interpretive Statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Cherry, Jacob. (2011). Contemporary Nursing: Issues, Trends, and Management [VitalSouce bookshelf version]. Retrieved from http://online.vitalsource.com/books/978-0-323-06953-3/id/B9780323069533100054_f0015
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