week2

Professional Identity and First Impressions

  • Nurses rank high on the list of most respected professions.
  • First step in fostering trust is to be present and engaged in a professional manner.

Components of Professional Nursing

  • Nurses do not become professionals simply by receiving a license.
  • Professionalism is learned over years of engagement with:
    • Comprehensive educational programs
    • Competent role models
    • Field experiences

Professional Behaviors

  • Core components include: competence, collaboration, advocacy, caring interventions, and ethics.
  • Key component: nurse’s commitment to behaving professionally.

Professional Dress

  • Professional dress demands:
    • Personal cleanliness and a clean uniform
    • Hair secured away from face
    • No long fingernails or artificial nails
    • No chewing gum
    • No excessive jewelry
    • No strong perfumes or cologne

Professional Demeanor

  • Maintain a professional, calm demeanor:
    • Avoid loud talking
    • Maintain a positive attitude
    • Avoid personal calls at work
    • Do not discuss personal problems with or complain to clients
    • Never breach patient confidentiality
    • Avoid gossiping with coworkers
    • Do not use personal cell phone to document patient information
    • Do not share patient information over social media
    • Be punctual

Teaching and Learning

  • Formation and progression through five stages:
    • Novice
    • Advanced beginner
    • Competent
    • Proficient
    • Expert
  • Licensed nurses are expected to maintain and update their knowledge base through their career.

Nursing Organizations

  • American Nurses Association (ANA):
    • Represents the interests of nurses across the U.S. and focuses on improving healthcare standards and promoting nursing excellence.
    • Developed the code for nurses, defining responsibility for upholding client rights.
    • ANA Code of Ethics; student nurses can sign up (Nursing Students membership & benefits).
  • National League for Nursing (NLN):
    • Focuses on advancing nursing education and promoting the interests of nurse educators.
  • Many other specialty nursing organizations exist.

Accountability

  • Ability to answer for one’s own actions.
  • Expectation of accountability and competence begins as a nursing student and continues throughout practice.
  • Nurses must continue education and stay up to date on practice standards.
  • Each nurse should pinpoint areas of strength and weakness.
  • Nurses are guided and assisted by professional organizations.

Collaboration

  • Skill in working as a team member.
  • Contributes to how others view the nurse as a professional.
  • Improves quality of care delivered to patients.

Advocacy

  • Practice of expressing and defending a client’s health, wellness, safety, wishes, and personal rights, including privacy.
  • ANA Code of Ethics emphasizes patient advocacy as a key concern.
  • How can a nurse act as an advocate?
    • Patient advocacy is essential for patients in vulnerable populations (e.g., disabilities, mental health diagnoses).
  • Nurses are accountable for advocating for patient safety at all times and in all settings.

Caring Interventions

  • Caring interventions involve attitude and compassion as a key to professionalism.
  • Compassion is an awareness of and concern about others’ suffering.

Ethics

  • Ethics is the study of conduct and character.
  • A code of ethics provides a guide for expectations and standards of a profession.

Ethics cont.

  • Principles and values guide human behavior and decision‑making.
  • Adhere to the ANA Code of Ethics for Nurses.
  • Evaluate potential ethical conflicts between personal ethics and professional role.
  • Integrity: adherence to a moral or ethical code.

Unprofessional Behaviors

  • Abuses of power, sexual harassment, bullying, harassment, improper use of authority, intimidation.

Nurse Practice Act

  • A Nurse Practice Act is a set of state statutes regulating nursing practice to protect the public.
  • Includes:
    • Educational requirements for nurses
    • Defining scope of practice
    • Licensure requirements
    • Enforced by State Boards of Nursing (BON)

Scope of Practice

  • Nurses are held to standards for licensure and grounds for revocation in their state.
  • Variation exists state to state for Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs).

Licensure

  • Licensure provides legal privilege to practice as defined by each state’s NPA.
  • BON oversees licensure examinations (NCLEX-RN for Registered Nurses, NCLEX-PN for Practical/ Vocational Nurses).
  • BON monitors continuing competency and annual license renewal.
  • BON takes action against nurses with unsafe practice or professional misconduct or failure to meet renewal requirements.

Standards for Nursing Practice

  • Nursing profession self-regulates by:
    • Defining the practice of nursing
    • Researching and developing practice
    • Establishing standards of practice
    • Providing education and credentialing
  • ANA has established Standards of Clinical Nursing Practice, including:
    • Standards for nursing care
    • Standards for professional performance
    • Defining what a client can expect in nursing care

Nursing Team

  • Roles include:
    • Registered Nurse (RN)
    • Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
    • Unlicensed Assistive Personnel (UAP): certified nursing assistants, hospital attendants, nurse technicians

PN Scope of Practice

  • Educational preparation must meet State Board of Nursing requirements.
  • Requires vocational or community college education prior to licensure exam.
  • Roles and responsibilities:
    • Works under supervision of an RN
    • Collaborates within the nursing process, assists with care plan, consults with team, recognizes need for referrals
    • Possesses technical knowledge and skill
    • Participates in delivering nursing care

PN Scope Cont.

  • Provides direct patient care under the direction of an RN, physician, or other licensed practitioner.
  • Basic patient care; Medication administration (except IV push in some states); wound care; client health assessments (not initial); documentation; collaboration; education reinforcement.

Out of Scope of Practice

  • Initial client admission to a facility.
  • Initial client health assessment.
  • Some facilities may allow RN cosign.
  • Intravenously pushed (IVP) medications and blood administration.
  • Initial client teaching; can reinforce teaching.
  • Clinical decisions; changes in client condition require RN notification.

Delegation

  • Delegation is transference of responsibility and authority for an activity to a competent individual.
  • Key issue: the person who delegates remains accountable.
  • The five rights of delegation: right task, right circumstances, right person, right direction/communication, right supervision/evaluation.

Delegation cont.

  • The person delegated to must have:
    • Knowledge and skill to perform the task
    • Demonstration of competence
    • Appropriate licensure for the task

Examples of tasks that may be delegated to PNs (Licensed Practical Nurses)

  • Monitor findings as input to the RN’s ongoing assessment.
  • Reinforce client teaching from a standard care plan.
  • Perform tracheostomy care, suctioning, NG tube patency checks.
  • Administer enteral feedings.
  • Insert urinary catheter.
  • Administer medications (excluding IV medications in some states).

Legal Issues

  • Legal issues in nursing encompass rights, responsibilities, and scope of practice defined by state nurse practice acts and by criminal and civil laws.

Legal Issues - Nursing

  • All patients have a legal right to expect competent nursing services.
  • Nursing students must be prepared to provide safe care consistent with legal requirements.
  • Malpractice: conduct deviating from the standard of practice dictated by a profession.
  • Nurses must know regulations of healthcare providers, institutions, payment systems, and federal/state laws apply to healthcare.

Laws

  • Tort Law defines and addresses unintentional and intentional actions or omissions that cause harm.
  • Types of torts:
    • Unintentional: negligence, malpractice
    • Intentional: assault, battery, false imprisonment, invasion of privacy

Negligence

  • Conduct that deviates from what a reasonable person would do in a given circumstance.
  • A negligent act occurs when an individual damages person or property without intent to injure.
  • May be due to carelessness (e.g., failure to implement safety measures for a client at risk for falls).

Malpractice

  • Malpractice includes acts and omissions by a professional while performing duties.
  • A major area of law for nurses; may jeopardize a nurse’s license and patient safety.
  • Nursing students are held to the same standard of conduct as licensed nurses.
  • Example: administering a large dose due to miscalculation, causing harm.

Elements to Prove Negligence

  1. Duty to provide care as defined by a standard.
  2. Breach of duty by failure to meet standard (e.g., fall risk assessment not performed).
  3. Foreseeability of harm (failure to address risk could endanger client).
  4. Breach of duty causing harm.
  5. Harm occurred to the client (e.g., fall).

HIPAA and Privacy

  • Health Insurance Portability and Accountability Act (HIPAA) of 1996:
    • Minimize exclusion of preexisting conditions as barrier to insurance, designates rights for individuals who lose coverage, and eliminates medical underwriting in group plans.
    • Establishes the Privacy Rule: a national standard for disclosure of private health information.

Private Health Information

  • Privacy Rule protects information that identifies an individual.
  • Access to medical records is regulated under the Privacy Rule.

Confidentiality

  • Confidentiality: assurance that private information will not be disclosed without patient consent.
  • Applies to both the nature of information and how it is treated after disclosure.

Confidentiality (cont.)

  • How to handle confidentiality:
    • Obtain information appropriately.
    • Disclose information only as permitted.
    • Advocate for confidentiality.
    • Be familiar with agency policies and procedures for protecting privacy.

Mandatory Reporting

  • Mandatory reporting is a legal requirement to report designated acts/events per state/local law.
  • Nurses are typically required to report: abuse or suspected abuse; certain injuries/illnesses (e.g., communicable diseases); crimes involving minors.

Mandatory Reporting (cont.)

  • Nurses must report incompetent, unethical, or illegal conduct.
  • Reports may involve violence, abuse, neglect toward patients or other nurses, or conduct by family members or other providers.
  • Report through the chain of command and may be required to report to the institution and the state BON.

Impaired Healthcare Providers

  • If a nurse suspects a coworker’s behavior that jeopardizes client care or indicates possible substance use, there is a duty to report to the appropriate manager.

Good Faith Immunity

  • Healthcare workers are protected from civil/criminal liability when reporting suspected abuse in good faith.
  • May be required to disclose protected health information; this is not considered a HIPAA violation in these circumstances.

Responsibility

  • Personal responsibility: all nurses, including students and practitioners.
  • Never perform an act you are unsure how to perform.
  • Show accountability for your actions.
  • Admit errors when they occur.
  • Know and follow facility policies and procedures.
  • Understand how to report errors.

Reporting Errors and Near Misses

  • Nurses have an ethical and legal responsibility to report errors and near misses.
  • Use incident reports to improve patient safety and care quality.
  • Failure to report may breach duty and could lead to malpractice.

What is Ethics?

  • Ethics refers to standards of right and wrong that influence human behavior, including rights, obligations, benefits to society, fairness, and virtues.
  • In professional nursing, ethics is a system of moral principles governing behaviors and relationships based on professional beliefs and values.

Values

  • Values are personal beliefs about truths and worth of behaviors, thoughts, objects.
  • Values provide the foundation for ethical standards within individuals or groups.

Values Essential for Professional Nurse

  • Altruism
  • Autonomy
  • Human Dignity
  • Integrity
  • Social Justice

Altruism

  • Concern for the welfare and well-being of others.

Autonomy

  • Right to self-determination.

Human Dignity

  • Inherent worth and uniqueness of individuals and populations.

Integrity

  • Honesty and adherence to a strong ethical framework in professional practice.

Social Justice

  • Upholding justice and fairness on a social scale.

American Nurses Association Code of Ethics

  • A general guide for the profession’s membership and social contract with the public.
  • Initially created in the 1950s and last updated in 2015.
  • Serves as a statement of nurses’ ethical obligations and duties, the profession’s nonnegotiable ethical standard, and commitment to society.
  • It is vital for nurses to be familiar with the ANA Code of Ethics (see Module 44 Box 44.2 for the 9 provisions).

Ethical Principles

  • Autonomy
  • Beneficence
  • Justice
  • Veracity

Autonomy

  • Right to self-determination.
  • Patients have the right to determine their own care; nurses honor decisions even if they conflict with what nurses believe is best for the patient.
  • Violating autonomy occurs when a nurse disregards patient choices.

Beneficence

  • Actions that promote good for the patient.

Nonmaleficence

  • A commitment to do no harm.

Justice

  • Treating all patients fairly, in accordance with standards or laws.

Veracity

  • Truth-telling; honesty and transparency.

Applying Principles

  • The goal of ethical reasoning is to reach a decision that is in the patient’s best interest and preserves integrity for all involved.
  • Responsible ethical decision-making should be rational, systematic, and based on ethical principles and codes of ethics, not on emotions, impulsive decisions, fixed policies, or precedent.

References

  • Pearson (2024). MyLab Nursing with Pearson etext access card for nursing: A concept-based approach with clinical nursing skills (4th ed.)