An influential nursing theory is the Theory of Interpersonal Relations which emphasizes the role that the relationship between persons has in therapeutic interactions. It allows an educated nurse to recognize the needs of the patient and respond appropriately. In practice, the theory is applied to improving patient experiences. Peplau argued that research in nursing should focus on patient needs and perceptions, based on the care received from nurses. Better experiences and satisfaction in patients have been associated with positive outcomes and at the very least contribute to enhanced communication and understanding between a patient and a nurse (Hagerty et al., 2018). In personal practice, interpersonal relations are important to me. Even when in a rush, I attempt to connect with patients and understand their needs. It helps to communicate their treatment needs to physicians as well as build rapport with a patient that enhances aspects such as patient education and adherence to treatment post-discharge.
Florence Nightingale is probably one of the most influential nursing figures of the 19th century, known as the founder of the nursing discipline. Meanwhile, Virginia Henderson is a 20th-century figure who is known to have defined modern nursing as a profession and created the use of theory in modern nursing. Nightingale virtually founded nursing, seeking to professionalize nursing and establishing the first nursing school in London. She also sought to implement social healthcare reforms in England and began to develop early aspects of public health education (The University of Alabama at Birmingham, n.d.). Meanwhile, Henderson established modern nursing as a profession and science. Being an avid scholar, Henderson developed the fundamentals of nursing theory and research, which is now the foundation of evidence-based practice and other vital nursing elements and practices used by nurses around the world. She established the 14 basic components of nursing care which are the paradigms of modern healthcare (AAHN, n.d.).
Both figures arguably influence my personal practice. Nightingale is an inspiration with her dedication to defining nursing as a vital profession in society, helping women essentially enter the medical field. Her passion and dedication to nursing and helping the public are inspiring in a manner that motivates my personal approach to care. Meanwhile, Henderson emphasized the need for organization, theory, and research in nursing. I value the efficacy of evidence-based practice and strive to apply it to my practice and studies. The theoretical foundations of nursing are able to drive its practical aspects.
The ANA is more of an advocacy and standard-setting organization. It establishes a scope of practice, standards, and code of ethics for nurses – all of which influence the general and daily practice as I have to adhere to these principles. Nurses join the ANA for advocacy and to advance the nursing profession. Meanwhile, the state board is a regulatory agency that oversees nursing practice and licensed nurses. The state board influences practice by defining the scope of practice based on the state Nurse Practice Act and enforces any regulations (ThriveAP, 2017). In Texas, RN licenses renew every two years, on the last of the nurse’s birth month. Texas has a continuing education requirement, 20 hours every 2 years in the area of practice, as well as 2 hours for geriatric care, and 2 hours for nursing jurisprudence/ethics every 6 years (Texas Board of Nursing, n.d.a). If an individual fails to renew the license, it becomes lapsed legally. Practicing with a lapsed license is a criminal offense in Texas and prevents a nurse from working until officially certified again. In a compact state, it means that a nurse can have one license to practice in multiple states, currently, 34 states have enacted Nursing Licensure Compact (NLC) legislature. In a non-compact state, you can have as many licenses as needed, but they are all only single-state licenses.
FDA oversees the marketing and use of medical products and medications, while CMS oversees reimbursement of healthcare products and services for the federal programs Medicare and Medicaid. As evident, both agencies regulate differing elements of nursing practice, but both share an interest in the safety and effectiveness of medical products and services. Nurses continuously utilize various medical devices in treatment and administer medication. It is vital for these to be FDA approved and often one has to ensure the FDA has allowed for the use under specific conditions. Meanwhile, CMS plays a role in the reimbursement process. Nurses use specialized codes when diagnosing and assigning treatment, which in turn lead to specific charges and reimbursements to the hospital (Institute of Medicine, 2009).
Complementary and alternative therapies (CAM) have been gaining recognition in the medical community and can contribute to the holistic treatment of a patient, some demonstrating even positive physiological effects in certain neurological conditions. The role of a nurse is to guide the patient, by understanding the aspects of CAM and how it may possibly interact with primary treatment and prescribed drugs as some interactions may be negative. It also necessary to educate the patient that CAM is a supplementary approach for holistic treatment, but should not be relied upon to treat any given condition, with adherence to primary treatment still being vital (Fowler & Newton, 2006).
In the state of practice, which is Texas, RNs have an independent scope of practice that does not require supervision. RN practice includes providing nursing services such as comprehensive assessments, nursing assessments, plans of nursing care, implementation interventions as well as teaching and training patients or other nurses. In Texas, regular RNs are not allowed to perform a medical diagnosis or prescribe therapeutic or corrective measures unless licensed as an APRN (Texas Health and Human Services, n.d.). Texas defines delegation as authorizing an unlicensed person to provide nursing services while retaining accountability for how they perform it. The state code recognizes that delegation should be dependent on a range of factors such as patient condition as well as experience and education level of the person. However, guided by rules 224 and 225, it is recommended to not delegate tasks that require nursing judgment (assessment, care plan, implementation), and cannot be safely and properly performed by an unlicensed assisted person (UAP), and adequate RN supervision. Sterile and invasive procedures as well as administration of medication are also recommended not to be delegated (Texas Board of Nursing, n.d.b).
Scientists are those who are studying or have expert knowledge of natural or physical sciences. Therefore, nurses are scientists since they consistently research and study information about the medicine and medical advancements. Nurses are detectives because they serve as a frontline for the treatment of patients, having to figure out potential diagnoses and seek out clues via symptoms and tests/analyses to determine the nature of the illness and how to treat it most effectively. Finally, nurses are managers of the healing environment as they oversee multiple aspects of frontline care, ensuring that patients are looked after, treated, information collected, and all needs are tended to. The profession requires complex management of tasks and information to achieve a smooth experience for the patients.
Code of Ethics
Provision 1 which focuses on compassion and respect for the human dignity and worth of each patient is critical to nursing practice which focuses on providing optimal and universal health care to all people regardless of background and belief. It is a principle that drives me to be humane and compassionate, attempting to understand the needs of patients in the context of the professional relationship and do my best to treat them while taking their wishes into account. Provision 4 indicates that a nurse has the authority, accountability, and responsibility for nursing practice (American Nurses Association, 2015). This impacts my practice by guiding my decision-making to remain ethical, legal, and according to medical standards. While healthcare contexts can be complex at times, I understand my responsibility to myself, the patients, the hospital, and the public to provide the best care as allowed by regulation of the specific jurisdiction of practice.
An error that may occur in clinical practice is potentially a medication error, where I get distracted or called away during medicine distribution, and as a result, provide a wrong dosage to a patient. This error may cause discomfort to the patient or potentially an adverse event. Under Provision 4, I would be responsible for the error and should take full accountability as I would not have provided optimal care. Regardless of being overwhelmed with tasks during work, it remains my duty to pay attention and demonstrate competency by providing the optimal prescribed medication dosage.
The top four qualities of nursing leadership are communication, emotional intelligence, strategic and critical thinking, honesty, and ethics. As a leader at the bedside, these qualities come into play as nurses have to oversee patient care and be accountable (Larsson & Sahlsten, 2016). Communication is vital for collaboration between staff, and emotional intelligence is key to understanding patient needs and directing care to meet them. Strategic and critical thinking approaches medical problems in a manner that can resolve complex situations, while honesty is integral to open communication and garnering respect to lead the care.
Similarly, within a disciplinary team, communication is absolutely vital to manage and direct complex care with multiple providers to ensure efficiency and effectiveness. Multidisciplinary teams consist of various people with different emotions and needs, so emotional intelligence helps to understand them and find ways of connecting people so that they are able best to work together without conflict. Honesty plays a large role in this as people expect leaders to behave ethically and through example, demonstrate inherent openness with them. Finally, strategic thinking helps for a planned and competent approach to treatment in a manner that utilizes the strengths of the multidisciplinary teams to the best outcome for the patient (Tiferes & Bisantz, 2018).
Work environments contribute to the effectiveness of nurse leadership and the overall cohesiveness of staff with their ability to remain focused and loyal to the leader. Positive work environments typically create a buffer against negative influences, helping a nurse leader to have better connections and communications with staff, in turn increasing their satisfaction and retention (Sherman, 2015). Similarly, work environments can influence decision-making both psychologically and socially, a factor that significantly impacts performance. According to Ceschi et al. (2017), work environment domains such as the demands of the job, available resources, emotional exhaustion, and presence of support affect decision-making competency. Based on the factors above, the work environment also typically affects professional development, by both creating and stunning motivations for staff to grow professionally as well as providing the necessary resources to achieve it. In a negative environment, retention is low, and people seek to ‘escape’ rather than develop for the benefit of themselves and the organization. Meanwhile, positive work environments oftentimes motivate their staff and provide adequate support such as training programs or tuition reimbursement, with nurses much more likely to commit to a professional partnership with the organization where they are satisfied.
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