Why define nursing?
Establishes the boundaries of the
profession and clarifies the purpose and
function of nursing
Factors that complicate socialization as
a new nurse
-Strong moral or ethical beliefs
- Conflicting personal and professional
values
- Unexamined biases
- Distance learning
Benner's States of Nursing Proficiency
Novice, Advanced Beginner, Competent
Practitioner, Proficient Practitioner,
Expert Practitioner
Reality Shock
Feelings of powerlessness and
ineffectiveness experienced by new
graduates
Compassion Fatigue
A condition in which one experiences
loss of physical energy, burn-out,
accident proneness, emotional
breakdowns, apathy, indifference, poor
judgment, and disinterest in being
introspective
Work-Life Balance
Creating a balanced life rather than
merely maintaining a balancing act
between work and home responsibilities
How do you care for your profession as
a nurse?
1. Join professional organizations
2. Protect the image of nursing
3. Maximize your education
4. Promote civility
Nursing practice is regulated at the...
state level (not national)
Purpose of licensing
Protect the public health, safety, and
welfare by creating standards for nurses
to practice
State Nursing Practice Acts
1. Defines the practice of professional
nursing
2. Sets the minimum educational
qualifications and other requirements for
licensure
3. Determines the legal titles an
abbreviations nurses may use
4. provides for disciplinary action of
licensees for certain causes
State Boards of Nursing (SBN)
Responsible for executing laws over
nursing practice at the state level
Licensing Powers
Nursing schools are approved by the
state; they have no legal need for
national certification
Licensure Exam
NCLEX-RN (same exam across all 50
states)
Licensure by Endorsement
All states recognize licensure awarded
by taking the NCLEX-RN so nurses may
be licensed in another state by
submitting proof of licensure and a fee
Nurse Licensure Compact (NLC)
Allows an RN to have their licence in
one state and practice in another state
without retaking the NCLEX-RN
Legal risks in professional nursing
practice
1. Malpractice - negligence
2. Delegation - allowing someone below
you to act on your behalf
3. Informed Consent - patient must give
consent voluntarily and in sound mind
Confidentiality
Protection of private information
gathered about a patient during the
provision of health care services
HIPAA - Health Insurance portability
and Accountability Act
First federal privacy standard governing
protection of patients' medical records:
1. Patients can see their medical
records and request corrections
2. Providers must inform patients written
notice of their rights
3. Limitations are placed on what info
can be shared, where it can be shared,
and who can be present when it is
shared
Informed Consent
1. Consent must be given voluntarily
2. Consent must be given by an
individual with the capacity and
competence to understand
3. The patient must be given complete
and accurate information
Assault
A threat or an attempt to make bodily
contact with another person without
their consent (becomes battery if the
threat is acted out)
Role changes in health care
1. Prescriptive Authority
2. Supervision of Unlicensed Assistive
Personnel (LPN/LVN)
Protecting yourself from legal problems
1. Practice in a safe setting
2. Communicate with other health
professionals, patients, and families
3. Meet the standard of care
4. Carry liability insurance
5. Promote positive interpersonal
relationships
- Saves money for health care facilities
- RN responsible for actions of UAP or
LVN
- National Nurse Aide Assessment
Program (NNAAP) certifies nurse aides
Values
Attitudes, ideals, or beliefs that an
individual or a group holds and uses to
guide behavior
Morals
Provide standards of behavior that
guide the actions of an individual and
are established rules to be used in
situations where a decision about
right/wrong must be made
Ethics
What actions an individual should take
and may be defined (in a code of ethics,
rule book, etc.)
Bioethics
Application of ethical theories and
principles to moral issues or problems in
health care
Moral Distress
A response to a siatuion when nurses
are faced with ethical dilemmas but also
encourter institutional constraints that
limit their actions
Deontology
Ethical action consists of doing one's
duty or honoring one's obligations to
human beings: to do one's duty was
right; to not do one's duty was wrong
Utilitarianism
Fundamental belief that the morla
rightness of an action is determined
solely by its consequence
Virtue Ethics
Delegation from RN to LPN
Virtues are tendencies to act, feel, and
judge that develop through appropriate
training but come from natural
tendencies
Principalism
Uese key ethical principles (like
autonomy, beneficence,
nonmaleficence, etc.) in the resolution
of ethical conflicts or dilemmas
Autonomy
Individuals have the right to determine
their own actions and the freedom to
make their own decisions
Beneficence
Doing good to others and acting in their
best interest no matter what
Nonmaleficence
The duty to do no harm
Justice
Equals should be treated the same and
unequals should be treated differently
Fidelity
Faithfulness or honoring one's
commitments or promises
Veracity
Telling the truth
Ethical Decision-Making Model
1. Clarify the ethical dilemma
2. Gather additional data
3. Identify options
4. Make a decision
5. Act
6. Evaluate
Dilemmas in nursing
Can result from:
1. Personal value systems
2. Peers' and other professionals'
behavior
3. Patients' rights
4. Institutional and social issues
5. Patient data access issues
Novice Stage
Benner Stage 1:
- enrolled in nursing school
- depend on rules
Advanced Beginner Stage
Benner Stage 2:
- Marginally competent skills
- difficulty establishing priorities
Competent Practitioner Stage
Benner Stage 3:
- 2-3 years experience
- feel competent and organized
- multitask
Proficient Practitioner Stage
Benner Stage 4:
- 3-5 years experience
- see patients holistically
- leaders in their units
Expert Practitioner Stage
Benner Stage 5:
- over 5 years experience
- perform intuitively
- act on the basis of their feeling of
rightness of nursing action
- hard to explain choices because they
are so engrained