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The professionalism framework continues to require nurse practice through qualitative and patient efforts. Nursing administration is advanced by sound and evidence-based management techniques (Melnyk & Fineout-Overholt, 2011). A shift in the healthcare sector, such as more workplace diversity, new technology, and, more importantly, accountability for fitness, bodily connection, and a new spiritual focus on the mind, necessitates innovative leadership, innovation, and management models. Productivity and cost are still important considerations, but there is an equal, if not greater, emphasis on quality relationships, safety, and healing environments. Core competencies apply to all professionals and place a strong emphasis on the integration of disciplines in order to foster a culture focused on safety outcomes and health care improvement. Evidence-based management and transformational leadership are necessary for redesigning our contemporary health care system (Melnyk & Fineout-Overholt, 2011).
General systems theory
It is an organic approach to the study of the general relationship between the human thought and empirical universe of an organization. The argument comes from the biology field and poses an analogy between the social and organism organization. General systems concepts form the theoretical underpinning for other leadership and management theories (Dossey, 2012). Sciences as a discipline have bodies of knowledge that grow with meaning full information. The empirical universal gives the general phenomena relevant to various disciplines.
Nursing as a discipline of my choice has a different phenomenon that interacts dynamically among them including the practical nurses, professional nurses and unlicensed, assistive nursing personnel as well as professional nursing researchers, managers and teachers (Harrington, 2008). Through the experience and knowledge, they grow. The media for growth are the interpersonal processing, relationship, communication, information which is essential phenomena. With the emerging changes in health care systems, nurse leaders need to increase the changes in the nursing organization. Followers of the systems concepts will also have to implement the integration of the material, machines, peoples and time.
Historical nursing figures
Watson’s theory of caring
Caring is the principal to nursing and most individuals choose nursing as a professional because they desire to take care of others. According to the Jean Watson, a science is one that encompasses the human knowledge orientation, humanitarian, rational, caring process, and the experience (Dossey, 2012). Watson claims that the transpersonal caring acknowledges connections and unity of life that move in the concentric circles of caring. Caring science embrace inquiry that is interpretive, subjective and objective-empirical. Additionally, the caring science inquiry consists of the ontological, ethical, historical, philosophical and studies (Butts & Rich, 2012). An example of the Watson’s theory of caring is the Attending Nursing Caring Model (ANCM). It serves as programs for simulating the profession and professional practices; when the nurse is experiencing the shortages and decline, crises and safety, hospital and health reform.
Peplau’s theory defines nursing as a “ significant, therapeutic, interpersonal process.” (Dossey, 2012). The approach involves such concepts as a definition of the problems, assessment, communication techniques, goals, direction and role clarification. Peplau states that four factors make up the primary components of the nurse-patient relationship: patient, nurse, client needs and professional expertise. The nurse-patient relationship has three phases: orientation, working and resolution phase. The mutual effort of the nurse-patient relationship includes identification of the presenting problems, understanding the issues and their variation in the pattern; and applying, appreciating and testing remedial measures a to give benefit results to the patients.
State Board of Nursing and American Nurse Association
States of nursing are the government agencies charged with regulating the nursing practice (Harrington, 2008). The board protects public by ensuring that there is meeting of nursing practice and that the nurses are competent in their profession. First, the board interprets and enforces the state nurses practice act (Harrington, 2008). Secondly, accredit and approves the nurse's education programs, Thirdly, develop policies, administrative regulation, and rules. Fourthly, they build nursing practice standard from the regulatory standpoint. Finally, administer nurse’s licensure by the overseeing exams to grant licenses and taking action against the licenses of nurses who display unsafe nursing practices. On the other hand, a nursing association such as American Nurses Association advances the profession of nursing (Dossey, 2012). ANA suggest new forms of exercise for the expertise to integrate. Unlike the board of nursing, the nursing association does not have the power to enforce the laws. Occasionally, a nursing organization can make a recommendation that board of nursing does not or do take a lot of time to adopt(Dossey, 2012).
As a professional nurse, the nurse's practice acts define the responsibility and scope of practice as well as qualification for practice. The acts are relevant in the nursing profession as they intend to protect patients from harm as results of incompetent practice or unqualified nurses (Dossey, 2012). Additionally, as professional nurse, the nurse's act describes what constituent unprofessional misconduct or conducts, and investigates and takes disciplinary procedures for the complaints against a nurse.
Arizona is a compact state (Winland-Brown et al., 2015). Primary states of residency are where one vote, pay taxes and hold a driver’s license. Renewal requirement for the applicant must practices as nurse for 960 hours or more in the past five years (Harrington, 2008). Secondly, must be a graduate from a nursing school and possess a degree for the past five years. Also, one should complete an Arizona board approved refresher course in the past five years. Or one should have an advanced nursing degree in 5 years ( LPN to RN, RN to BSN, masters, or doctorate) (Herrera, 2013).
Nurse licensure compact is an agreement assisting mutual recognition of a nursing professional between members of the United States. Member states allow that a nurse resides in and possess a current nursing; license in a country that is an NLC states (Harrington, 2008). Enacted by the participating states, it applies to practical and registered nurse. While license of nurse may be compacted, permanent relocation to other states requires obtaining licensure in the new state, since the residence changes (Harrington, 2008). One of the provisions of the enacted nurse compact needs all nurses to pass criminal background before they can get a compact nursing license (Winland-Brown et al., 2015). Therefore, in non-compacted states, as a registered, licensed practical or vocation nurse, one needs to sit for NCLEX-RN or NCLEX-PN boards and meet the requirement for an APN license in your state (Harrington, 2008). When one passes exams and meet the APN requirement, the issuance of the practicing nursing as RN, LPN/VN or APN happen. However, if one decides to work for another state, there is applying for the second license while keeping the first one. The approach has been in existence for the 100 years (Harrington, 2008). Therefore, the processes are cumbersome and costly. However, NLC centers mainly on the criminal background. The enacted compact requires checks and mandates that if the nurses’ CBC is positive for the felony under state or federal law, then no issuing of the multistate license (Winland-Brown et al., 2015). But, a nurse with a real felony background can get a single-state license in her or his home state, not any privilege of practicing in foreign countries (Harrington, 2008).
FDA and Centre for Medicare and Medicaid services
“The centers for the Medicare and Medicaid services provide health coverage to more than 100 million people through Medicare, Medicaid, the children’s health insurance programs and the health insurance marketplace” (Perry et al., 2013). The CMS modernizes the nation’s health care system, to provide access to high-quality care and improved health at lower costs. It makes sure that its beneficiaries are aware of the services which they are eligible and accessible. It ensures its policies promote efficiency and quality of total care delivery systems. Medicaid is federal and state programs that help cater medical expenses for low-income patients (Harrington, 2008)
The food and drug administration has a place in managing the health information technology. The FDA evaluates the medical devices and classifies according to the level of risk they represent. FDA regulates the safety and effectiveness of the medical devices. FDA also assigns the medical devices, software, and equipment to categories of regulatory control.
Being a professional nurse, the FDA is essential to my nursing line of duty. Patient and health professional advocacy groups are part of the FDA’s primary stakeholders (Dossey, 2012). FDA has an outreach effort beyond the usual meetings. The association keeps in touch with the stakeholders throughout the year where they provide information on the public meeting, clinical trials, and current FDA draft guidance’s and device and drug approvals.
Apart from the 2010 Affordable Care Act, United States were to expand its Medicaid cover up to 138% of poverty level but in 2012, the US supreme states that it could opt out of the programs (Harrington, 2008). However, there are 16 states in US and district of Columbia expanding the Medicaid. Nurses always advocate for the patient's access to health care (Harrington, 2008). Evidence shows that Medicaid expansion is reducing the amount of the uninsured people and providing cash to the hospitals. In the past, poor results were seen as inevitable effects of illness and injury (Melnyk & Fineout-Overholt, 2011). However, nurse or health providers are beginning to identify areas for improvement. Therefore, professionals should provide a preventive care and identify those at high risk and find community resources to help them. Nurses should involve themselves in the policy-making rather than wait and see on the payers and policymakers. Conversion, mostly affects physicians and advanced nurses who make a diagnosis. For instance, the pressure ulcers are diagnosed using a nursing documentation to show their severity. Nurses need to make sure their documentation is by the 123 medical diagnoses for pressure ulcers in the ICD-10 system (Dossey, 2012).
According to the ANA, the nurses promote, advocates and protect the rights, safety, and health of the patients. Therefore, as the patients requesting of the alternative therapy, it is the role of the professional to preserve the human dignity, respects the worth and uniqueness of every patient. Finally, as advocates, they should be available for the patients and their families as advocates for their wellbeing. Similarly, the advocate should help the patient to make informed decisions and makes patients a priority. As an advocate, also it is vital to help the patients who have difficulties in paying for the prescriptions.
Purpose of Nurse Practice Act
The Arizona State Nurse Practice Act (ASPA) defined the scope of practice specific to a registered nurse, an advanced nurse practitioner and licensed practical nurse and nurse anesthetist (Herrera, 2013). It represents all the law that regulates the nurse’s scope of practice in the Arizona state. The laws protect the patients as well as lay the rules and regulations for a particular level of a nurse’s licensure and educational. The practice establishes the standard and the codes of ethics for practitioners at various levels of expertise (Butts & Rich, 2012).
Arizona state of nursing protects and promotes the welfare of the public by ensuring that each holds a nursing license or certificate is competent to practice safely (Herrera, 2013). According to the Arizona Nurse Practice Act, completing an assessment is a critical boundary between the LPN and RN scope of practice (Herrera, 2013). RN professional may independently assess the health status of the groups and individuals and treat human responses to actual or potential health hitches, but a practical nurse is limited to performing activities under a physician. According to the Arizona state, Advanced Practice Registered Nurse (APRN) may work as RN (Herrera, 2013). Arizona state board nursing acknowledges there are times when nurse chose to undertake a role that is different than the highest level of nursing licensure. A nurse is held to the practice standard of the highest level of nursing licensure held (Dossey, 2012). Thus, APRN working as RN would resolve with the scope of practice and RN job description. The APRN functioning as an RN would not discharge a patient, order laboratory test or prescribe medication but will be held accountable for APRN specialty area practice standard since the nurse is responsible for the highest nursing credential field (Harrington, 2008).
All nurses delegate tasks while at work. Asking unlicensed assistant personnel to assist in feeding, bathing or other activities help in saving time tremendously. There are five guidelines to direct one in the process of delegating roles in the Arizona state: First, the right of circumstance for the patient to receive the care (Herrera, 2013). Second, right tasks for the individual to perform. Third, the right person to deliver the responsibility for the patient. Fourth, the proper supervision to ensure the work is carried out safely and finally, adequate information to describe desired patient results. Improper delegation may lead to liability claims against the nurse, license provocation or disciplinary actions.
Scientist, detective and manager healing environment
The core roles of the nurse’s scientist are to provide leadership in the coordination, development, and management of clinical research studies. Also, nurses scientist contribute to the overall health sciences literature. Similarly, leads evaluation activities that can improve the result for the patient participation in research studies at the health center. Finally, provides the mentorship programs for the nurses in research.
Nurses and detectives have a trustworthy team to back them up to get the best results. Detective nurses can give high-quality care to patients and solve the crimes. Nurse detective should possess good observational and critical thinking skills to gather evidence, sorts the facts and examine with excellent details to come up with the conclusion (Melnyk & Fineout-Overholt, 2011). Detectives solve the crime to get the criminal in the community and nurses prevent illness and assist a patient to recover. So if you are RN, LPN, feel free to call yourself a nurse detective.
The nurse manager’s role is providing a healthy work environment. The workplace is vital in setting aura for the nursing leader to address the social, physical, mental and economic welfare of the employee (Dossey, 2012). The most crucial aspect of a healing environment for patients is a nurse manager who has a positive work environment.
American nurse association (ANA) code of ethics
Preserving human dignity and making an informed decision is one of the codes of ethics in the American Nurses Association (Butts & Rich, 2012). In many medical situations, families and patients are confused and anxious. Being calm, as an experienced nurse I can help patients to navigate unfamiliar systems and communicate with the doctors. Also, I can give the education to the patients about the procedure and tests. As professional nurses, being aware of how ethnicity and culture can affect the patients’ experiences while abiding by the privacy law is essential. As a licensed nurse, in a unique position which allows integrating all aspect of the patient's care, ensuring the standard are upheld, concerns are addressed, and positive results remain the objective. As a nurse, the most ways I can advocate for the patients is ensuring they have the right to an informed decision about the health. Even if the patients refuse to takes medication or decline to make a particular drug, as a professional nurse I should accept the conclusion of the patients. In case the doctors do not agree, it is my duty as a nurse to provide information to the patient.
Nursing errors commonly revolve around patient’s medication error, infections documentation and equipment injuries (Dossey, 2012). Medication error is one of the clinical errors which occur when administering the medications. The nurse should have a minimal distraction. In the United States, a medication error kills one individual daily according to the National Medication Error Reporting Programs. Consulting with other medical team members is helpful. Always keep in mind the health care provider still retains the culpability in a case for the wrong medication. Therefore, communication is essential for the patients especially if he or she can communicate and also with other healthcare providers.
A nurse should possess the following traits; professional socialization, mentorship role, positive result oriented and leadership activities of senior nurses. A leader at the bedside: supervised learning in clinical practice promotes emotional intelligence, motivation, responsibility and deeper understanding of the patient’s relationship and identity of the nurses. Hospitals having strategies will lead to increased patient satisfaction, more efficient nurse-patient relationship and quicker recovery period. Mentorship is essential in the health of patients as it improves her or his health. Mentorship enables the nurses to have a mastery of new skills, and hence the patients can get the best health care.
Within a nursing team or interdisciplinary team: senior’s nurses should be able to develop other team members to apply the theory to practice and encourage them to test new skills in a supportive and safe environment (Dossey, 2012). Leadership is the driving forces of the work environment and directly affects staff morale and motivation. Mentorship is vital since it empowers and highlights the nursing roles. Goals of any health care are to influence the quality of patients cares through good nursing leadership. Professional socialization is a learning way that occurs in a work environment, of which the lower nurses are an integral part (Dossey, 2012).
Positive practice environment is the setting that supports decent and excellent work. Individually, managers struggle to ensure the health, personal wellbeing of the staff, safety, support, and quality of patient health care and improve the motivation, performance, and productivity of organization and individuals. As nurse professional, our working environment is favorable for effective decision making and professional development.
The organization climate reflects an effective leadership and management, excellent peer support, colleague’s participation in the decision making with shared values. The place has a healthy work-life balance which enables career development. Combination of the event and favorable working environment empowers the growth in the professionalism. The area also present open transparency and communication with recognition programmers which enables the working environment to be desirable due to the ability to acknowledge the positive and challenges the adverse outcome. Working senior nurses in our place of work allows development of other staff by enabling them to test new skill in a safe and supportive environment. The top managers use the transformational models in operation. It offers the durability in the relationship between senior nurses and junior colleagues. The seniors use transformational to alters the goals and values of the other staff to achieve common purpose to benefit the nursing profession and the employing firm (Dossey, 2012).
The scope and standard for the health care providers provide a conceptualization for practice. A theory of nursing is a general method of management that governs the practical use of material and human resources. Nurse Managers with skills and knowledge in human behaviors manage professional nurses and nonprofessional assistive nursing worker to achieve the highest level of efficiency and productivity of patient health care services (Dossey, 2012). To ensure effectiveness, the nurse managers must become competent to stimulate motivation through an interpersonal process, relationship, and communication with the workforce. Nurse managers work with the staff comprising of clinical practitioners. Educated in nursing management, they can assist the practitioners in their task according to the models of such theorist as Watson and Peplau.
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.
Dossey, B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-Director International Nurse Coach Association. (2012). Holistic nursing. Jones & Bartlett Publishers..
Harrington, C. (2008). Nursing home staffing standards in state statutes and regulations. Retrieved December, 10(2008), 13.
Herrera, C. (2013). Quantitative Analysis of Variables Affecting Nursing Program Completion at Arizona State University. Research in Higher Education Journal, 21.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Maternal child nursing care. Elsevier Health Sciences.
Winland-Brown, J., Lachman, V. D., & Swanson, E. O. C. (2015). The new code of ethics for nurses with interpretive statements. 2015: Practical clinical application, Part I. Medsurg Nursing, 24(4), 268-71.
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