N112 Professional Standards - Spring 2024 PDF

Professional Standards in Nursing Theresa Antonio, MSN, CCRN, TCRN N112: Intro to Professional Nursing Role [email protected] 1 Objectives for this lecture: For detailed objectives and content outline, please refer to your N112 syllabus A. Professional standards of nursing practice B....

Professional Standards in Nursing Theresa Antonio, MSN, CCRN, TCRN N112: Intro to Professional Nursing Role [email protected] 1 Objectives for this lecture: For detailed objectives and content outline, please refer to your N112 syllabus A. Professional standards of nursing practice B. Nursing Practice Act C. Applies ANA standards of professional practice to nursing practice D. Nursing Code of Ethics 2 Taylor, C., Lynn, P., Bartlett, J. L., 10th edition Required Reading: Chapter 1, pp. 15-19 Chapter 6, pp. 124-138 Chapter 7, pp. 146-166 Chapter 12, p. 311 www.rn.ca.gov ▪ Nursing Practice Act Statutes and Regulations 3 N112 PROFESSIONAL STANDARDS – SPRING 2024 1 Professional Standards of NURSING PRACTICE 4 NURSING AS A PROFESSION: Knowledge and application of theory into clinical practice Guided by professional and ethical standards Evidence-based practice (EBP) interventions 5 NURSING AS A PROFESSIONAL DISCIPLINE Well-defined body of specific and unique knowledge Strong service orientation Recognize as an authority by a professional group Code of ethics Professional organization that sets standards Ongoing research Autonomy and self-regulation 6 N112 PROFESSIONAL STANDARDS – SPRING 2024 2 CALIFORNIA BOARD OF NURSING (BRN) Title 16 Section 1443.5 “A registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process…” https://www.rn.ca.gov/pdfs/regulations/npr-b-53.pdf 7 California Board of Nursing Standards “… supports the right of all consumers to receive dignified and competent health care consistent with the law and prevailing standards of care… the nurse to know the patient's diagnosis/suspected diagnosis in a timely fashion to make an appropriate nursing care plan. Knowledge of the patient's diagnosis(es) by the registered nurse is essential so that the registered nurse may initiate any additional precautions necessary to minimize the risk of contracting or spreading disease. … It is not acceptable to abandon any patient, nor is it acceptable to refuse to treat any person base on age, religion, sex, national origin, sexual orientation, or disability.” 8 AMERICAN NURSING ASSOCIATION (ANA) “Nursing incorporates the art and science of caring and focuses on the protection, promotion, and optimization of health and abilities,” (ANA, 2021). The ANA describes competent level of nursing care as demonstrated by the applying the nursing process in every stage of care. Nursing process includes Assessment, Analysis, Planning, Intervention, and Evaluation (AAPIE) 9 N112 PROFESSIONAL STANDARDS – SPRING 2024 3 ANA Standards of Nursing Practice 1. 2. 3. 4. 5. Assessment Analysis / Diagnosis Outcomes Identification Planning Implementation 5a. Coordination of Care 5b. Health Teaching and Health Promotion 6. Evaluation 10 Significance of Standards of Nursing Practice Standards of Nursing Practice Authoritative statements that all RNs are expected to perform competently ALL RNs are expected to follow and meet the nursing process as proof of compliance. 11 STANDARDS OF NURSING PRACTICE STANDARDS allow nurses to carry out professional roles, serving as protection for the nurse, the patient and the institution Each nurse is accountable for their quality of practice and is responsible for the use of these standards to ensure knowledgeable, safe, and comprehensive nursing care. 12 N112 PROFESSIONAL STANDARDS – SPRING 2024 4 ANA STANDARD OF PRACTICE Standard 1. ASSESSMENT The RN collects pertinent cues/data and information relative to the patient’s health or the situation Collects pertinent cues such as: demographics, SDOH, health disparities, physical, functional, emotional, cognitive, etc. Assess parameters set by the WORLD HEALTH ORGANIZATION (WHO), Healthy People 2030 and 2024 National Patient Safety Goals (NPSG) by Joint Commission 13 ANA STANDARD OF PRACTICE Standard 2. DIAGNOSIS / ANALYSIS Analyzes assessment data to determine actual or potential diagnoses, problems, and issues. Identifies ACTUAL or POTENTIAL patient problem(s) Uses assessment data to identify the most pressing/critical/crucial patient problem Prioritizes patient problems Documents patient problem(s) 14 ANA STANDARD OF PRACTICE Standard 3. OUTCOME IDENTIFICATION Identifies DESIRED SMART OUTCOME for an individualized plan OUTCOME(S) must be: SPECIFIC MEASURABLE ATTAINABLE REALISTIC TIME-BOUND 15 N112 PROFESSIONAL STANDARDS – SPRING 2024 5 ANA STANDARD OF PRACTICE Standard 4. PLANNING Develops a plan that prescribes SMART strategies Interventions must be: Individualized Evidenced-Based Prioritizes elements of the plan based on the patient’s cues (assessment data) 16 ANA STANDARD OF PRACTICE Standard 5. IMPLEMENTATION Implements the identified plan Partners with patient and interdisciplinary team Demonstrates caring behavior that promotes therapeutic relationships Integrates CLINICAL JUDGMENT to implement the nursing process Document implementation and any modification, including changes, or omissions, of the identified plan 17 ANA STANDARD OF PRACTICE Standard 6. EVALUATION Evaluates progress towards DESIRED SMART outcome/goal Uses ongoing assessment cues to revise the plan, outcomes, and implementation strategies 18 N112 PROFESSIONAL STANDARDS – SPRING 2024 6 Standards of care and Competent performance comes from: Internal Standards Institutional Standards (Hospital Policies and Procedures) External Standards American Nursing Association California Board of Registered Nursing Community Standards 19 JOB DESCRIPTION INTERNAL STANDARDS EDUCATIONAL REQUIREMENTS HOSPITAL (Institutional) POLICIES AND PROCEDURE 20 ANA EXTERNAL STANDARDS Nurse Practice Act Joint Commission AACN, ENA, NSNA 21 N112 PROFESSIONAL STANDARDS – SPRING 2024 7 COMPETENT NURSING Applies the nursing process in all aspect of care Skilled in all aspect of basic nursing care Meets their patients’ health care needs through their technical, cognitive, interpersonal, and ethical/legal skills Takes responsibility for evaluating their own strengths and weaknesses so that the patient receives optimal care. Employs precautionary measures that renders safe care Adheres to legal boundaries, policies, procedures and protocols 22 Nursing Practice Act 23 NURSE PRACTICE ACT Laws established in EACH STATE that regulate the practice and licensure of nursing Goal is to protect the public Creates a regulatory body such as the State BRN to make and enforce rules and regulations concerning the nursing profession Defines important terms and activities in nursing Establish criteria for the education and licensure of nurses Defines scope of practice and responsibilities for RNs 24 N112 PROFESSIONAL STANDARDS – SPRING 2024 8 California Nurse Practice Act https://www.rn.ca.gov/practice/npa.shtml Under the State of California Department of Consumer Affairs California Business and Professional Code California Code of Regulations 25 BOARD OF REGISTERED NURSES ROLES: State government agency Established by the nurse practice act Regulates nursing practice Protect the public Implements and enforces the Nurse Practice Act and laws related to: Nursing Education Licensure Practice Discipline 26 Nurse Practice Act: Student Nurse Article 2: Scope of Regulation 2729 states: Students may render nursing services when these services are incidental to the course of study of one of the following: Student is enrolled in a board-approved prelicensure program or School of Nursing Nurse licensed in another state or country, taking a board-approved continuing education course or a post-licensure course 27 N112 PROFESSIONAL STANDARDS – SPRING 2024 9 STUDENT NURSE As a student nurse, You are responsible for your own acts, including any negligence that may result in patient injury You are held to the same standards of care as an RN You are also responsible for being familiar with facility policies and procedures 28 Successful completion of an accredited nursing program ENTRY INTO NURSING PRACTICE Clear criminal background Passing the National Council Licensing Examination-Registered Nurse (NCLEX-RN) 29 LICENSURE “…professional license is to protect the public from harm by setting minimal qualifications and competencies…” NCSBN, 2011 30 N112 PROFESSIONAL STANDARDS – SPRING 2024 10 RN STATE LICENSURE Legal permit granted by the state to individuals to engage in nursing practice Licensure means the individual demonstrated minimal competence in nursing To renew license: 30 Continuing education units (CEU) every 2 years 31 DISCIPLINARY ISSUES: Nursing Practice Act Violations Depends on offense, rehab evidence, safe practice, mitigating factor, past hx Unprofessional conduct Incompetence Gross negligence Practicing without a license Falsification of clients’ records Illegally obtaining, using or possessing controlled substances Having a personal relationship with a client 32 ANA Standards of Professional Performance 33 N112 PROFESSIONAL STANDARDS – SPRING 2024 11 7. Ethics 8. Culturally Congruent Practice 9. Communication ANA Standards of Professional Performance 10. Collaboration 11. Leadership 12. Education 13. Evidence-Based Practice and Research 14. Quality of Practice 15. Professional Practice Evaluation 16. Resource Utilization 17. Environmental Health 34 NURSING AS A COLLABORATIVE ROLE Functioning effectively within your professional and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care 35 Patient advocate Collaborative roles Coordinator of Services Patient and Family Educator/ Counselor 36 N112 PROFESSIONAL STANDARDS – SPRING 2024 12 Nursing Code of Ethics 37 Common principles of ETHICAL CODES American Nurses Association International Council of Nurses National Student Nurses’ Association 38 ANA Code of Ethics The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. 39 N112 PROFESSIONAL STANDARDS – SPRING 2024 13 Nurses Bill of Rights 1. Full authority for nurses to practice at the top of their license, credentials, and professional standards without barriers, and in a manner that fulfills their obligations to society, patients, and communities. 2. Continuous access to training, education, professional development, as well as pathways for nurses to be recognized as leaders and in roles to direct shared decision-making on nursing practice, resources, staffing concerns and patient safety issues. 3. Work and practice in environments that ensure respect, inclusivity, diversity, and equity with leaders who are committed to dismantling systemic racism and addressing racist behaviors that negatively impact nurses of color. 4. Just care settings that facilitate ethical nursing practice, standards, and care in accordance with the Code of Ethics for Nurses with Interpretive Statements. 5. Safe work environments that prioritize and protect nurses’ well-being and provide support, resources, and tools to stay psychologically and physically whole. 40 Nurses Bill of Rights 6. Freedom for nurses to advocate for their patients and raise legitimate concerns about their own personal safety without the fear of retribution, retaliation, intimidation, termination, and ostracization. 7. Competitive compensation consistent with nurses’ clinical knowledge, experience, and professional responsibilities and that recognizes the value and rigor of nursing practice. 8. Collective and individual rights for nurses to negotiate terms, wages, and work conditions of their employment in all practice settings. 41 Moral Distress “Moral distress is phenomenon when an individual knows the right thing to do but cannot pursue that action due to organization or other constraints. The definition has further developed into a well-recognized concept occurring when providers are involuntarily complicit in an unethical act, but are powerless to change the situation” (Hamric & Epstein, 2017) 42 N112 PROFESSIONAL STANDARDS – SPRING 2024 14 Moral Resilience “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks” (Rushton, 2016a, p. 112a) 43 Conscientious Objection “Where nurses are placed in situations of compromise that exceed acceptable moral limits or involve violations of the moral standards of the profession, whether in direct patient care or in any other forms of nursing practice, they may express their conscientious objection to participation. Where a particular treatment, intervention, activity, or practice is morally objectionable to the nurse, whether intrinsically so or because it is inappropriate for the specific patient, or where it may jeopardize both patients and nursing practice, the nurse is justified in refusing to practice on moral grounds” (ANA, 2015a, p. 21)” 44 Diversity, Equity, and Inclusion (DEI) Paternalism Ethical Issues Encountered by Nurses Deception Privacy (HIPAA) and social media Valid Consent or Refusal Questionable practices of healthcare workers Beginning-of-life or end-of-life issues Conflicts Concerning New Technologies 45 N112 PROFESSIONAL STANDARDS – SPRING 2024 15 ANA Social Media Principles: 1.Be aware of your audience. Make sure that the content of your posts is appropriate for the people who will be seeing it and may share it with others. 2. Maintain your professionalism. Avoid posting anything that could be considered unprofessional or inappropriate, such as photos or videos of patients. 3. Know your social media policy. Familiarize yourself with your employer’s social media policy and adhere to it across all the social media platforms that you choose to use. 4. Secure your social media profiles. Review and set-up the respective privacy settings for the social media platforms that you choose to use. 5. Share credible information only. The dissemination of credible and reliable information protects the health and well-being of the public. 6. Engage with respectful content. Do not share content that is harmful, disparaging, racist, homophobic, or derogatory. (American Nurses Association, 2019) 46 Department of Health Aervices LA General medical center Rancho Los amigos Olive view medical center Harbor-UCLA medical center Los Angeles county CONAH 47 48 N112 PROFESSIONAL STANDARDS – SPRING 2024 16 49 References American Nurses Association. (2019). ANA social media principles. American Nurses Association. https://www.nursingworld.org/social/ Taylor, C., Lynn, P., Bartlett, J. L. (2023). Fundamentals of nursing: The art and science of person-centered nursing care (10th ed.). Philadelphia: Wolters Kluwer. California Board of Nursing. (1997). NPR-B-03 06/1995 AN EXPLANATION OF SCOPE OF RN PRACTICE INCLUDING STANDARDIZED PROCEDURES BOARD OF REGISTERED NURSING AN EXPLANATION OF THE SCOPE OF RN PRACTICE INCLUDING STANDARDIZED PROCEDURES. https://www.rn.ca.gov/pdfs/regulations/npr-b-03.pdf American Nurses Association. (2018). EXPLORING MORAL RESILIENCE TOWARD A CULTURE OF ETHICAL PRACTICE. https://www.nursingworld.org/~4907b6/globalassets/docs/ana/ana-call-to-action-exploring-moral-resilience-final.pdf National Council of State Boards of Nursing. (2015). What You Need to Know About Nursing Licensure and Boards of Nursing. https://www.ncsbn.org/Nursing_Licensure.pdf 50 N112 PROFESSIONAL STANDARDS – SPRING 2024 17