Running head: SELF-ASSESSMENT OF NURSING STANDARDS
Self-Assessment of Medical-Surgical Nursing Standards of Professional Performance
Adrianne Tozer
Ferris State University
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Abstract
It is imperative all nurses are guided by a select set of nursing standards. I have worked as a
medical-surgical nurse for ten years and have chosen to perform an analysis of my practice using
the Nursing Standards of Professional Performance set fourth by the Academy of MedicalSurgical Nurses. After the analysis was complete, I was able to develop measureable goals
which will demonstrate how competency in each of the standards will be attained and
maintained. Each goal has an action plan with specific timelines which can be measured for
success. This process has afforded me the opportunity to examine my strengths and weaknesses
but more importantly has given me the chance to guide my future nursing practice.
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Self-Assessment of Medical-Surgical Nursing Standards of Professional Performance
The purpose of this paper is to critically analyze my current nursing practice and develop
a plan for how I will maintain and attain the expected Standards of Professional Performance set
fourth by the Academy of Medical-Surgical Nurses. I have been a nurse for sixteen years and
ten of those years have been as a medical-surgical nurse. Medical-surgical nursing is a specialty
practice area in professional nursing. “The practice of medical-surgical nursing requires
specialized knowledge and clinical skills to manage actual or potential health problems that
affect individuals, their significant others, and the community” (Academy of Medical-Surgical
Nurses, 2012, p. 4). Two more semesters remain before I graduate from Ferris State University
(FSU) with my Bachelor of Science in Nursing (BSN). The program has been rigorous and I
have made huge strides in my nursing practice. However, there is always room for growth,
improvement and further education. In order to progress, I will depend on the Medical-Surgical
Nursing Standards of Professional Performance for guidance. The standards explain behaviors
which are expected in the professional nursing role and include quality of care, performance
appraisal, education, collegiality, ethics, collaboration, research, resource utilization,
communication and leadership (Academy of Medical-Surgical Nurses, 2012).
Description and Analysis of Current Behaviors
Quality of Care
It does not matter what your nursing experience, education, specialty or work setting;
providing quality of care is of upmost importance. “Medical-surgical nurses engage in the
evaluation of care delivery through a systematic quality assessment and performance
improvement process” (Academy of Medical-Surgical Nurses, 2012, p. 15). The number one
factor in quality of care is patient safety. I am continuously striving to keep my patients safe at
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all times by following policy and procedures, identifying areas of quality improvement and
participating in committees which initiate changes to strengthen clinical practices. Currently, I
am involved in a committee which is centered on improving the patient hand-off process from
the emergency department to the medical-surgical floor. Recently, my nurse manger has
requested I join a venous thromboembolism (VTE) task force in order to lower the rate of blood
clots seen on the floor. This entails collecting and analyzing data, identify areas of improvement,
implementing changes and evaluating for effectiveness. I also keep abreast on quality of care
issues by attending nursing meetings and reviewing new or updated policies.
Performance Appraisal
Performing a self-evaluation of one’s nursing practice can be challenging. It involves
recognizing both weaknesses and strengths. According to the Academy of Medical-Surgical
Nurses (2012) performance appraisal is needed because nurses are accountable to the public for
providing competent care and we have an obligation as professionals to assess our practice. I
receive a yearly evaluation from my nurse manager and occasionally participate in peer reviews.
My nursing performance is also assessed by comparing myself against other nurses with
exceptional nursing skill and leadership. Additionally, patient evaluations and comments are
great resources for gauging my success as a nurse. There is nothing better than hearing a patient
tell me I did a great job caring for him or her. However, I do have some room for improvement
in meeting this standard. When a mistake or shortcoming has been brought to my attention,
either through self-evaluation or feedback from others, I tend to feel incompetent. This is
counterproductive because instead of learning from my errors, I beat myself up.
Education
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Besides quality of care, education is my top priority of all the professional standards.
The Academy of Medical-Surgical Nurses (2012) states,” Scientific, cultural, social, and political
changes require a continuing commitment from medical-surgical nurse to pursue knowledge to
enhance nursing expertise and advance the profession” (p. 16). Since the start of my nursing
career I have had educational goals. I started off as a nurse aide in home care and from there
became a Licensed Practical Nurse (LPN). After working as a LPN for twelve years I went back
to school and earned my Associates Degree in Nursing. The next step started in 2012 when I
enrolled at FSU to earn my Bachelors in Science of Nursing (BSN) degree. I will be finished
with this degree in August 2014 and already planning on continuing my education by enrolling
in the Master of Science in Nursing (MSN) program through FSU.
Collegiality
Countless opportunities present themselves daily, allowing for the opportunity to interact
and contribute to the growth of nurses and other healthcare professionals alike. “To enhance
professional growth of others, medical-surgical nurses are responsible for sharing knowledge,
evidence, research , and clinical information with colleagues through formal and informal
teaching and collaborative programs” (Academy of Medical-Surgical Nurses, 2012, p. 16). I
have really surprised myself by the amount of information I share with the nurses on my unit.
Since returning to school I am constantly gaining new knowledge which I am always eager to
share with my coworkers. At work, in an informal manner, I pose questions, debate issues,
discuss evidence-based reach findings and quality initiatives with my peers. This not only
allows others to gain knowledge but fosters my own learning by listening to the perspective and
opinion of others. I take opportunities to train new nurses on the floor and I volunteer as a
resource person for our new electronic charting program.
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Ethics
Ethics is a standard I have come to understand more about throughout my education at
FSU. The Academy of Medical-Surgical Nurses (2012) states the public holds both humane
healthcare and trust in nurses so it is our duty to assure care is provided in accordance with the
patient’s needs, wishes and values. I always provide care which supports patient autonomy and
rights. Whenever the opportunity arises I advocate for the patient and their families. I maintain
a professional relationship with my patients, yet provide compassionate care. Providing privacy
is always incorporated into my practice such as closing the privacy curtain, maintaining
confidentiality and abiding by the Health Insurance Portability and Accountability Act. I am
truthful in my communication with patients, other healthcare professionals and in my
documentation. In order to meet a cultural enrichment requirement for my BSN I enrolled in
Medical Bioethics, last semester. This class really opened my eyes to all the ethical dilemmas
surrounding healthcare and the various ways to handle the situations. Sharing thoughts, concerns
and ideas about ethical issues with other staff members is helpful not only in assessing my own
beliefs but in understanding the beliefs and values of others.
Collaboration
Collaboration takes place on a daily basis with information shared between the patient,
family and other healthcare professionals. According to the Academy of Medical-Surgical
Nurses (2012) “Through the collaborative process, different abilities of health care providers are
used to solve problems, communicate, and plan, implement, and evaluate health care services”
(p. 18). Since I work the midnight shift my collaboration efforts are sometimes limited. Often I
share my thoughts and concerns with the day shift nurse and rely on her to collaborate with the
appropriate person. I always have the opportunity and obligation to collaborate with the patient.
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It is so important to keep the patient involved in their care to promote autonomy, ease fears, set
goals and educate. I also work closely with the patient’s family to make decisions and problem
solve. For example, we may discuss safety measures to use in the home after knee replacement
surgery. Next to the patient, I probably collaborate with other nurses the most buy asking
questions and getting their opinion.
Research
It is imperative the nursing profession accumulate knowledge through evidence-based
research. “Medical-surgical nurses are responsible for contributing to the further development of
healthcare by participating in research” (Academy of Medical-Surgical Nurses, 2012, p. 18). Of
all the standards this is probably my weakest area. Any research I have performed relates to
meeting school requirements. Of course, any new information learned through the process is
extremely helpful to my practice. Now I find myself questioning the “why” behind particular
tasks or duties. According the Academy of Medical-Surgical Nurses (2012) research and
evidence should be critiqued. Recently my unit implanted bedside shift report. During an inservice my nurse manager discussed all the benefits to bedside shift report including increased
patient safety. However, when I performed a literature research on the topic, for a class project,
there was no supporting evidence to prove patient safety had actually increased. In other words,
there were no numbers to support this statement. I do believe there are many benefits to bedside
report but this is a good example showing my ability to question and critique information. The
VTE and patient handoff committees I am involved with also require research such as what nonpharmalogical interventions work best in clot prevention or the amount of medication errors
caused my miscommunication.
Resource Utilization
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With today’s economy and healthcare crisis, resource utilization is critical in the nursing
profession. “As the cost of health care increases, health care must be provided in a way that will
maximize resources and maintain quality of care” (Academy of Medical-Surgical Nurses, 2012,
p. 19). It can be challenging to cut costs yet provide high quality care. I have been a making an
effort to be resourceful and budget conscious by being mindful of supplies I bring into a patients
room. Once an item enters a room it can not be removed. For example, instead of taking in a ten
pack of briefs, I will only take in two or three. Midnight shift does not always have the
opportunity to work with nurse aides but when one is available I am able to delegate work. This
is cost-effective because it provides me extra time to perform duties which are specific to nursing
such as patient teaching. Without delegating, important nursing tasks may be overlooked due to
time constraints. Sometimes I work as a charge nurse and one of my responsibilities is calling off
nurses when patient census is low. I would like to see everyone come to work as scheduled but
understand the floor has a budget to maintain.
Communication
Communication is vital to patient safety and care. Without effective communication
errors can occur. The Academy of Medical-Surgical Nurses (2012) considers communication a
key element in patient safety, effective collaboration and high quality care. The benefits of good
communication skills are endless. I advocate for my patients, convey information and voice
concerns. When developing a teaching strategy one of the elements I take into consideration is
the form of communication which works best for the patient. For example, do they learn best by
reading, listening or viewing pictures/video? In order to prevent miscommunication I try to
speak clearly, professionally and to the point. When giving report or speaking with a physician I
use a standardized format called SBAR (situation, background, assessment and recommendation)
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which provides an effective and efficient way to communicate information. However,
communication includes more than verbal words. My facial expressions and body language
must show professionalism. This holds especially true when working with patients.
Unfortunately, communication can also cause conflict. I feel confident in my conflict resolution
skills to quickly resolve issues. I achieve this by staying calm, listening to others, keeping an
open mind and making compromises when needed.
Leadership
Being a leader is rewarding but not without challenges. “Medical-surgical nurses,
regardless of their position, have daily opportunities to demonstrate leadership. Medical-surgical
nurses model professional behavior, collaborate with and mentor colleagues, take action to
resolve conflict, and advocate for clients, workplace, and the nursing profession” (Academy of
Medical-Surgical Nurses, 2012, p. 20). I consider myself a leader in a multitude of ways but the
two most essential elements I possess are a commitment to my profession and life-long learning.
I am a team player, show respect, have a positive attitude and engage others. When the
opportunity arises, I volunteer to be a preceptor for new nurses and join committees in order to
make positive changes. Other staff members look up to me because of my experience and my
willingness to teach. I enjoy sharing new information with co-workers and offering advice.
Some of my strongest leadership skills were acquired by watching other effective nurse leaders.
Nursing leadership does not end in the work place. For example, I speak highly of the profession
in my community and with friends and family. When someone tells me they want to be a nurse I
offer encouragement and praise.
Goal Setting, Action Plan and Evaluation
Quality of Care
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My monthly involvement with the VTE and patient handoff committees will continue. If
the problems are resolved and the committee ends I will continue to volunteer with the
commitment to be in at least one quality improvement committee at all times. I can also take
initiative by making recommendations to my nurse manager where I feel quality improvements
are needed, based on my experience and education. Seeing patient improvements on my unit
will help me to evaluate the success of each quality improvement committee.
Likewise, I will stay current on nursing quality indicators, evidence-based reach and best
practice by reading nursing journals. However, right now I do not subscribe to any journals but
have wanted to for some time now. I reviewed various nursing journals on-line and have
decided on subscribing to the Journal of Nursing Care Quality. “The Journal of Nursing Care
Quality invites integrative reviews of current advances in patient safety, research on quality care,
approaches to improving quality and safety in health care and evidence-based practice in
nursing” (Journal of Nursing Care Quality, 2013, para 1). The cost is $123.00 for twelve
journals, over a one year period. My tax return money can be used to pay for the subscription
sometime between February and March 2014. Reading journal articles is not time consuming
and will help me gain useful information for my practice and quality initiative committees.
Performance Appraisal
This particular self-assessment assignment has been a good start in determining areas of
my practice which can be improved upon and also for reflection on my successes. My goal for
improving this standard is to engage in a self-assessment every January. My yearly assessment
will not need to be a lengthy paper but a simple list of the standards and time to reflect and plan
for the future. The benefits can be measured by comparing my progress from year to year. I will
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continue asking for guidance and direction from two other nurses who have more experience and
strong leadership skills. They can monitor my progress and communicate their thoughts.
Lastly, I need to work on becoming less defensive or feeling incompetent just because I
received some constructive criticism or made a mistake. After spending some time considering
my options I feel keeping a journal will help me best deal with this issue. I will begin keeping a
journal on January first of 2014. After experiencing any negative thoughts, I will write out the
events which lead to the feelings and what can be learned from them. I can also make notes on
how the issue or problem could have been handled differently thus allowing for a learning
opportunity.
Education
The standard of education is probably the easiest area for me to set goals in. I will be
finished with my BSN in August of 2014. Next, I will move into the MSN program in spring of
2015. My focus will be in nursing education. I have already looked into the application process,
requirements and types of classes offered. The plan is to take 2 classes a semester until my
degree is completed. The success of this plan can be measured each semester with good grades
and a greater knowledge base. My knowledge can than be applied into my practice and shared
with my co-workers.
Two additional goals I have in the area of education are to become Advanced
Cardiovascular Life Support (ACLS) certified as well as a certified medical-surgical nurse. I
spoke to my nurse manager about my plan and was told an ACLS class will be held April 11th,
2014 which I plan to enroll in. I have already looked into the cost and requirements for my
medical-surgical nurse certification through the Academy of Medical-Surgical Nurses. My goal
is to begin working on certification by February of 2015. The reason behind the lengthy wait is
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the hope for reimbursement. Reimbursement or financial incentives for certification may be
included into the new union contract which renews in January of 2015. Even if reimbursement
or financial incentives are not included I will go ahead and pay the fees myself. Becoming a
certified medical-surgical nurse along with earning my ACLS can be easily measured and
evaluated for success by passing the exams.
Collegiality
My community service project for FSU is teaching cardiopulmonary resuscitation (CPR),
automatic external defibrillator and first aid for the American Red Cross. This experience has
been absolutely wonderful! I even taught a CPR class at my facility for nurses and nurse aides.
Even though I have fulfilled my commitment for twenty hours of volunteer time, I still continue
to teach. On the average, I volunteer for one to two classes a month and will continue to do so.
The experience is rewarding and gives me invaluable experience toward my future goal of
becoming a nursing instructor as well as improving my patient teaching skills.
My facility implemented electronic medical records one year ago and I was asked to
become a resource person. My duties included problem solving and making sure the transition
process went smoothly. I continue to attend meetings every few months to learn about updates
and changes related to the system. In turn, I teach my co-workers the new information.
Exchanging information with other employees helps to build teamwork, knowledge and respect.
I am sure my duties will eventually end but if another opportunity comes along in the way of
teaching I will definitely volunteer.
Patient care is complex and requires many other healthcare professionals to assist in the
plan of care. I will continue to utilize other individuals from the interdisciplinary team such as
speech therapy, physical therapy and social workers. I value both their expertise and opinion.
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Maintaining a thorough understanding for their job duties will help me identify where they fit
into the plan of care and what outcomes can be expected. Often other disciplines hold inservices for nurses in order provide education and improve working relationships. For example,
just last month pharmacy held an in-service for the nursing staff on mixing intravenous
antibiotics after pharmacy closes (we do not have twenty-four hour pharmacy). I will continue
to attend interdisciplinary in-services when offered; in addition to providing any assistance
needed to other disciplines such as answering questions or providing education.
Ethics
Before returning back to school I did not have a solid foundation for handling ethical
issues. However, throughout my education at FSU I have gained considerable knowledge about
the ethical principles of healthcare, patient rights and the American Nurses Associations Code of
Ethics. Having a clear understanding for this information will allow me to be prepared when an
ethical issue arises. In order to remain competent in the standard of ethics I must read nursing
journals and learn not only from other nurses but from my own encounters with ethical
dilemmas.
My nursing practice is based on honesty, trust and respect for the patient and will
continue to remain so. I will always strive to provide care which is nonjudgmental and unbiased.
At times, all nurses find this difficult and I am no exception. Once again, using my journal will
allow me to sort out my own feelings on issues. This will help sort out my thoughts so I can
provide nonjudgmental care. The journal will also afford me to the opportunity to keep track of
ethical issues I have experienced over the years so I can learn from them.
Collaboration
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Patient care is complex and requires many other healthcare professionals to assist in the
plan of care. I will continue to utilize other individuals from the interdisciplinary team such as
speech therapy, physical therapy and dietary. I value both their expertise and opinion.
Maintaining a thorough understanding for their job duties will help me to better identify where
they fit into the plan of care and what outcomes can be expected. Often other disciplines hold inservices for nurses in order provide education and improve working relationships. For example,
just last month pharmacy held an in-service for the nursing staff on mixing intravenous
antibiotics after pharmacy closes (we do not have twenty-four hour pharmacy). I will continue
to attend interdisciplinary in-services when offered; in addition to providing any assistance
needed to other disciplines such as answering questions or providing education.
Besides the interdisciplinary team I must continue to interact and rely on other nurses. I
use my cohorts as professional resources and sounding boards. Rarely a day goes by in which I
do not ask another nurse for her expertise or opinion. It is for this reason, I will continue to
maintain positive relationships with my co-workers and request their support. However,
collaboration is a two way street and as much as I depend on others, they depend on me. I look
forward to helping and want to offer my very best. This means engaging in life long learning so
when another nurse asks for advice I can give her reliable information based on an educated
opinion and evidence-based research. Reading nursing journals and continuing my college
education will help me contain meeting this standard.
Research
I have found the research standard most difficult to meet. However, just because I am not
performing actual research does not necessarily mean research is void from my practice. Staying
current on evidence-based research by reading journals, attending seminars and continuing my
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education are all valid ways to meet this standard. Since research has been incorporated
throughout the FSU curriculum I now find myself asking more questions such as “why” and
“how”. No longer will I accept the response, “because we always do it this way”. Lastly, I will
use evidence-based research to base changes made in the quality improvement committees I am
involved in. This can easily be evaluated by seeing a steady increase of patient care based on
research, not only in my practice but the practice of other nurses on my unit.
Resource Utilization
I have become increasingly aware of the importance for resource utilization. This is
precisely why I am frugal with supplies, being sure to only take what is needed. As charge nurse
I will continue to consider the budget when staffing. One area I am going to improve upon is
becoming knowledgeable about the costs of supplies within the next six months. Of course, it is
not feasible to know the exact cost of every single item but prices of basic supplies will be
helpful. For example, how much is one brief or box of gauze pads. I will request my nurse
manager to post a price list in the supply room. If my manager does not have direct knowledge
of the prices than she can easily direct me to the person who does. This will be a good reminder
not only for me but other nurses on my floor to consider the impact finances plays on patients,
insurance companies and the hospital.
Communication
I recognize how communication is imperative to patient safety and the success of my
nursing career. I will continue to communicate with others in a direct, professional and
respectful manner while keeping in mind my body language and facial expressions. One way to
build upon the standard of communication is to continue teaching for the American Red Cross.
With each class I learn to convey information in a more effective manner. Periodically, classes
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become too large and I am assigned a co-teacher. I will take these opportunities to receive
feedback from other instructors on my teaching and communication skills. Student evaluations
can also provide constructive criticism which to learn from. My goal over the next year is to
continue to teaching at least one to two classes a month for the American Red Cross, paying
close attention to each student evaluation. I will then use the experience and evaluations to
improve upon my next CPR class but more importantly communication between my co-workers
and patients.
Leadership
The longer I practice nursing and with continued education my opportunity for leadership
experiences will continue to grow. My goal is to become a full time charge nurse on the
medical-surgical floor, where I currently work. I have already demonstrated my willingness for
this leadership challenge by making the request to my charge nurse. This is certainly not a goal
which can easily be obtained in a specific time frame. I must demonstrate my commitment to the
hospital, unit and co-workers by continuing to join quality improvement committees, earning my
ACLS certification and becoming a certified medical-surgical nurse (as addressed earlier under
other standards). These additional accomplishments will help prepare me for the challenges of
leadership. I will also continue to volunteer as a preceptor for new nurses when the opportunity
arises. Lastly, it is my goal to genuinely support other nurses by taking the time to acknowledge
their hard work and successes. So often hard work goes unnoticed but my goal is to genuinely
support other nurses by taking the time to acknowledge their hard work and successes. This can
easily be accomplished each shift I work by taking a moment to recognize at least one nurse for a
job well done. Throughout this class I have learned being a leader does not always mean
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knowing everything but adhering to high standards and noble qualities which begins with
appreciating others.
For each standard I have assessed there is plenty of room for growth and further
development. At the same time I can appreciate just how far I have come, especially since
embarking on my journey back to school. Gaining a stronger knowledge base has opened up my
mind to new ideas and the courage to step outside my comfort zone in order to improve my
practice. Lastly, I realize the importance of having an action plan along with a measurable
evaluation plan in order to reach future goals and maintain competencies. I look forward to
accomplishing all my goals and seeing where my success takes me.
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References
Academy of Medical-Surgical Nurses. (2012). Scope and standards of medical-surgical nursing
practice (5th ed.). Retrieved from http:www.amsn.org/practice-resources/scope-andstandards
Journal of Nursing Care Quality. (2013). Publish your integrative review in JNCQ. Retrieved
from http://journals.lww.com/jncqjournal/page3s/defaultx.aspx